Posterior leaflet shortening to correct systolic anterior motion after mitral valve repair.

In patients with degenerative mitral valve disease and tall leaflets, systolic anterior motion after mitral valve repair is generally avoided by use of a sliding posterior leaflet repair technique with an annuloplasty of appropriate size. Occasionally, in spite of these maneuvers, systolic anterior motion occurs intraoperatively after discontinuing cardiopulmonary bypass. In such cases, posterior leaflet shortening is a simple option that effectively moves the coaptation point of the mitral leaflets posteriorly, and eliminates left ventricular outflow tract obstruction caused by systolic anterior motion.