Mitral Valve Interventions for Hypertrophic Obstructive Cardiomyopathy

The mitral valve (MV) plays an important role in the pathophysiology of hypertrophic obstructive cardiomyopathy (HOCM). Dynamic left ventricular out fl ow tract (LVOT) obstruction, caused by systolic anterior motion (SAM), is a common occurrence in most patients with hypertrophic cardiomyopathy and is directly associated with the MV apparatus. First line therapy for HOCM patients is pharmacological, and surgical intervention is often indicated for patients who do not respond to medical therapy. Emerging research on mitral disease in HOCM, speci fi cally mitral regurgitation (MR), demonstrates that these patients frequently do not respond to standard therapeutic options, and can bene fi t from MV interventions. In this review, we describe the involvement of the MV in the pathogenesis of HOCM, discuss medical therapy, and explore available mitral procedures. Surgical myectomy, often combined with various modi fi cations to the MV apparatus, is frequently necessary to achieve a durable resolution of LVOT obstruction and SAM -related MR. Alcohol septal ablation , an alternative to surgical myectomy, will be brie fl y mentioned. We also emphasize the role of transcatheter edge -to -edge repair (TEER) as a promising and novel therapeutic option for HOCM patients. Over time, TEER has established itself as an effective and safe procedure, demonstrating success across a spectrum of anatomical variations. The lea fl et modi fi cation and movement restriction achieved through TEER help reduce SAM and, consequently, have the potential to alleviate LVOT obstruction and SAM -related MR. Furthermore, we propose a treatment algorithm for cases where TEER is a potential course of action for patients who are at high risk for other interventions.