Asymmetric Alfieri's stitch to correct systolic anterior motion after mitral valve repair.

Systolic anterior motion of the mitral valve is a feared complication after valve repair, with important implications in the postoperative period. Provocation with isoproterenol is valuable in the assessment of its mechanism and severity in high-risk patients. Surgical correction of this condition is sometimes difficult and may require valve replacement. We present a modification of Alfieri's edge-to-edge technique that adapts better to the mechanism of systolic anterior motion (SAM) after mitral repair in selected patients by placing the edge-to-edge suture between the A1-P1 segments and not in the midline.