The Experts below are selected from a list of 99 Experts worldwide ranked by ideXlab platform
Stanton K Shernan - One of the best experts on this subject based on the ideXlab platform.
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evaluation of transmitral pressure gradients in the Intraoperative echocardiographic diagnosis of mitral stenosis after mitral valve repair
PLOS ONE, 2011Co-Authors: Annkathrin Riegel, Holger K Eltzschig, Raila Busch, Scott Segal, John Fox, Stanton K ShernanAbstract:Objective: Acute mitral stenosis (MS) following mitral valve (MV) repair is a rare but severe complication. We hypothesize that Intraoperative Echocardiography can be utilized to diagnose iatrogenic MS immediately after MV repair. Methods: The medical records of 552 consecutive patients undergoing MV repair at a single institution were reviewed. Postcardiopulmonary bypass peak and mean transmitral pressure gradients (TMPG), and pressure half time (PHT) were obtained from Intraoperative transesophageal echocardiographic (TEE) examinations in each patient. Results: Nine patients (9/552=1.6%) received a reoperation for primary MS, prior to hospital discharge. Interestingly, all of these patients already showed Intraoperative post-CPB mean and peak TMPGs that were significantly higher compared to values for those who did not: 10.764.8 mmHg vs 2.961.6 mmHg; p,0.0001 and 22.967.9 mmHg vs 7.663.7 mmHg; p,0.0001, respectively. However, PHT varied considerably (87637 ms; range: 20–439 ms) within the entire population, and only weakly predicted the requirement for reoperation (113656 vs. 87637 ms, p=0.034). Receiver operating characteristic curves showed strong discriminating ability for mean gradients (AUC=0.993) and peak gradients (area under the curve, AUC=0.996), but poor performance for PHT (AUC=0.640). A value of $7 mmHg for mean, and $17 mmHg for peak TMPG, best separated patients who required reoperation for MS from those who did not. Conclusions: Intraoperative TEE diagnosis of a peak TMPG $17 mmHg or mean TMPG $7 mmHg immediately following CPB are suggestive of clinically relevant MS after MV repair.
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guidelines for the performance of a comprehensive Intraoperative epiaortic ultrasonographic examination recommendations of the american society of Echocardiography and the society of cardiovascular anesthesiologists endorsed by the society of thoraci
Journal of The American Society of Echocardiography, 2007Co-Authors: Kathryn E Glas, Jack S Shanewise, Joseph P Mathew, Scott Reeves, Madhav Swaminathan, David Rubenson, Peter K Smith, Stanton K ShernanAbstract:Kathryn E. Glas, MD, FASE, Madhav Swaminathan, MD, FASE, Scott T. Reeves, MD, FASE, Jack S. Shanewise, MD, FASE, David Rubenson, MD, FASE, Peter K. Smith, MD, Joseph P. Mathew, MD, FASE, and Stanton K. Shernan, MD, FASE, for The Council for Intraoperative Echocardiography of the American Society of Echocardiography, Atlanta, Georgia; Durham, North Carolina; Charleston, South Carolina; New York, New York; La Jolla, California; and Boston, Massachusetts
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transesophageal Echocardiography for detecting extrapulmonary thrombi during pulmonary embolectomy
The Annals of Thoracic Surgery, 2004Co-Authors: Peter B Rosenberger, Stanton K Shernan, Tomislav Mihaljevic, Holger K EltzschigAbstract:Background. Pulmonary embolectomy is an evolving surgical procedure for the treatment of severe pulmonary embolism. In addition to removing pulmonary thromboemboli, the achievement of optimal results also requires identification and extraction of intrathoracic, extrapulmonary thromboemboli from the right atrium, right ventricle, and the superior or inferior vena cava. Otherwise, these thromboemboli may become the source of recurrent pulmonary embolism. Intraoperative transesophageal Echocardiography is frequently used during pulmonary embolectomy as a guide for the surgeon and a monitor of cardiac performance. However, its utility for detecting concurrent intrathoracic, extrapulmonary thromboemboli has not been thoroughly investigated. Methods. The study population included 50 consecutive patients undergoing emergent pulmonary embolectomy. Results from preoperative diagnostic studies including transthoracic Echocardiography; ventilation/ perfusion scan, pulmonary angiography, and computed tomography were reviewed, along with the Intraoperative echocardiographic reports for the presence of intrathoracic extrapulmonary thromboemboli. In addition, the surgical operative notes were consulted to determine the impact of Intraoperative transesophageal Echocardiography on surgical decision making. Results. Extrapulmonary intrathoracic thromboemboli were identified preoperatively in 8 patients (16%). Intraoperatively, thromboemboli were identified in 5 additional patients by transesophageal Echocardiography, adding to a total of 13 patients with extrapulmonary thrombi (26%). Intraoperative transesophageal Echocardiography provided the sole source of evidence that directed surgical management in 10% (5 of 50) of all patients undergoing pulmonary emboletcomy. Conclusions. Intraoperative transesophageal Echocardiography identified intrathoracic, extrapulmonary thomboemboli in 26% of patients undergoing pulmonary embolectomy, resulting in an alteration of surgical management in 10% of patients. These findings support the critical role of Intraoperative Echocardiography during pulmonary embolectomy.
William J Stewart - One of the best experts on this subject based on the ideXlab platform.
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ase sca guidelines for performing a comprehensive Intraoperative multiplane transesophageal Echocardiography examination recommendations of the american society of Echocardiography council for Intraoperative Echocardiography and the society of cardio
Journal of The American Society of Echocardiography, 1999Co-Authors: Jack S Shanewise, Albert T Cheung, Solomon Aronson, William J Stewart, Richard Weiss, Jonathan B Mark, Robert M Savage, Pamela Searsrogan, Joseph P Mathew, Miguel A QuinonesAbstract:Since the introduction of transesophageal Echocardiography (TEE) to the operating room in the early 1980s,1-4 its effectiveness as a clinical monitor to assist in the hemodynamic management of patients during general anesthesia and its reliability to make Intraoperative diagnoses during cardiac operations has been well established.5-26 In recognition of the increasing clinical applications and use of Intraoperative TEE, the American Society of Echocardiography (ASE) established the Council for Intraoperative Echocardiography in 1993 to address issues related to the use of Echocardiography in the operating room. In June 1997, the Council board decided to create a set of guidelines for performing a comprehensive TEE examination composed of a set of anatomically directed cross-sectional views. The Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography has endorsed these guidelines and standards of nomenclature for the various anatomically directed cross-sectional views of the comprehensive TEE examination. This document, therefore, is the collective result of an effort that represents the consensus view of both anesthesiologists and cardiologists who have extensive experience in Intraoperative Echocardiography. The writing group has several goals in mind in creating these guidelines. The first is to facilitate training in Intraoperative TEE by providing a framework in which to develop the necessary knowledge and skills. The guidelines may also enhance quality improvement by providing a means to assess the technical quality and completeness of individual studies. More consistent acquisition and description of Intraoperative echocardiographic data will facilitate communication between centers and provide a basis for multicenter investigations. In recognition of the increasing availability and advantages of digital image storage, the guidelines define a set of cross-sectional views and nomenclature that constitute a comprehensive Intraoperative TEE examination that could be stored in a digital format. These guidelines will encourage industry to develop Echocardiography systems that allow quick and easy acquisition, labeling, and storage of images in the operating room, as well as a simple mechanism for side-by-side comparison of views made at different times. ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography
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Intraoperative Echocardiography is indicated in high risk coronary artery bypass grafting
The Annals of Thoracic Surgery, 1997Co-Authors: Robert M Savage, Bruce W Lytle, Solomon Aronson, William J Stewart, Jose L Navia, Michael G Licina, Norman J Starr, Floyd D LoopAbstract:Background. Intraoperative Echocardiography is a valuable monitoring and diagnostic technology used in cardiac surgery. This reports our clinical study of the usefulness of Intraoperative Echocardiography to both surgeons and anesthesiologists for high-risk coronary artery bypass grafting. Methods. From March to November 1995, 82 consecutive high-risk patients undergoing coronary artery bypass grafting were studied in a four-stage protocol to determine the efficacy of Intraoperative Echocardiography in management planning. Alterations in surgical and anesthetic/hemodynamic management initiated by Intraoperative Echocardiography findings were documented in addition to perioperative morbidity and mortality. Results. Intraoperative Echocardiography initiated at least one major surgical management alteration in 27 patients (33%) and at least one major anesthetic/hemodynamic change in 42 (51%). Mortality and the rate of myocardial infarction in this consecutive high-risk study population using Intraoperative Echocardiography and in a similar group of patients without the use of Intraoperative Echocardiography was 1.2% versus 3.8% (not significant) and 1.2% versus 3.5% (not significant), respectively. Conclusions. We conclude that when all of the isolated diagnostic and monitoring applications of perioperative Echocardiography are routinely and systematically performed together, it is a safe and viable tool that significantly affects the decision-making process in the Intraoperative care of high-risk patients undergoing primary isolated coronary artery bypass grafting and may contribute to the optimal care of these patients.
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do patients with less than echo perfect results from mitral valve repair by Intraoperative Echocardiography have a different outcome
Circulation, 1993Co-Authors: James Fix, Delos M. Cosgrove, Robert M Savage, Loretta R Isada, David P Miller, James M Blum, William J StewartAbstract:Background. Not all valve repairs for mitral regurgition (MR) have a perfect result, with no MR on postpump Intraoperative Echocardiography. Although more than 2+ MR by postpump Echocardiography has led to second pump runs for further surgery in 6% to 8% of our patients, those left with 1+ or 2+ MR, traditionally an acceptable result, have not previously been evaluated for clinical outcome. Methods and Results. Among 530 patients undergoing mitral repair during 1987 to 1989, 76 patients with 1+ or 2+ MR by postpump Intraoperative Echocardiography were compared with 76 patients who had equivalent age, sex, left ventricular function, and concominant surgery butwho had no MR by postpump echo
Floyd D Loop - One of the best experts on this subject based on the ideXlab platform.
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durability of mitral valve repair for degenerative disease
The Journal of Thoracic and Cardiovascular Surgery, 1998Co-Authors: Marc A Gillinov, Delos M. Cosgrove, Patrick M Mccarthy, Eugene H Blackstone, Ramon Diaz, John H Arnold, Bruce W Lytle, Nicholas G Smedira, Joseph F Sabik, Floyd D LoopAbstract:Abstract Background: Degenerative mitral valve disease is the most common cause of mitral regurgitation in the United States. Mitral valve repair is applicable in the majority of these patients and has become the procedure of choice. Objective: This study was undertaken to identify factors influencing the durability of mitral valve repair. Patients and methods: Between 1985 and 1997, 1072 patients underwent primary isolated mitral valve repair for valvular regurgitation caused by degenerative disease. Repair durability was assessed by multivariable risk factor analysis of reoperation. It was supplemented by a search for valve-related risk factors for death before reoperation. Three hospital deaths occurred (0.3%); complete follow-up (4152 patient-years) was available in 1062 of 1069 hospital survivors (99.3%). Results: At 10 years, freedom from reoperation was 93%. Among 30 patients who required reoperation for late mitral valve dysfunction, the repair failed in 16 (53%) as a result of progressive degenerative disease. Durability of repair was adversely affected by pathologic conditions other than posterior leaflet prolapse, use of chordal shortening, annuloplasty alone, and posterior leaflet resection without annuloplasty. Durability was greatest after quadrangular resection and annuloplasty for posterior leaflet prolapse and was enhanced by the use of Intraoperative Echocardiography. Death before reoperation was increased in patients having isolated anterior leaflet prolapse or valvular calcification and by use of chordal shortening or annuloplasty alone. Conclusions: Repair durability is greatest in patients with isolated posterior leaflet prolapse who have posterior leaflet resection and annuloplasty. Chordal shortening, annuloplasty alone, and leaflet resection without annuloplasty jeopardize late results. (J Thorac Cardiovasc Surg 1998;116:734-43)
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Intraoperative Echocardiography is indicated in high risk coronary artery bypass grafting
The Annals of Thoracic Surgery, 1997Co-Authors: Robert M Savage, Bruce W Lytle, Solomon Aronson, William J Stewart, Jose L Navia, Michael G Licina, Norman J Starr, Floyd D LoopAbstract:Background. Intraoperative Echocardiography is a valuable monitoring and diagnostic technology used in cardiac surgery. This reports our clinical study of the usefulness of Intraoperative Echocardiography to both surgeons and anesthesiologists for high-risk coronary artery bypass grafting. Methods. From March to November 1995, 82 consecutive high-risk patients undergoing coronary artery bypass grafting were studied in a four-stage protocol to determine the efficacy of Intraoperative Echocardiography in management planning. Alterations in surgical and anesthetic/hemodynamic management initiated by Intraoperative Echocardiography findings were documented in addition to perioperative morbidity and mortality. Results. Intraoperative Echocardiography initiated at least one major surgical management alteration in 27 patients (33%) and at least one major anesthetic/hemodynamic change in 42 (51%). Mortality and the rate of myocardial infarction in this consecutive high-risk study population using Intraoperative Echocardiography and in a similar group of patients without the use of Intraoperative Echocardiography was 1.2% versus 3.8% (not significant) and 1.2% versus 3.5% (not significant), respectively. Conclusions. We conclude that when all of the isolated diagnostic and monitoring applications of perioperative Echocardiography are routinely and systematically performed together, it is a safe and viable tool that significantly affects the decision-making process in the Intraoperative care of high-risk patients undergoing primary isolated coronary artery bypass grafting and may contribute to the optimal care of these patients.
Robert M Savage - One of the best experts on this subject based on the ideXlab platform.
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ase sca guidelines for performing a comprehensive Intraoperative multiplane transesophageal Echocardiography examination recommendations of the american society of Echocardiography council for Intraoperative Echocardiography and the society of cardio
Journal of The American Society of Echocardiography, 1999Co-Authors: Jack S Shanewise, Albert T Cheung, Solomon Aronson, William J Stewart, Richard Weiss, Jonathan B Mark, Robert M Savage, Pamela Searsrogan, Joseph P Mathew, Miguel A QuinonesAbstract:Since the introduction of transesophageal Echocardiography (TEE) to the operating room in the early 1980s,1-4 its effectiveness as a clinical monitor to assist in the hemodynamic management of patients during general anesthesia and its reliability to make Intraoperative diagnoses during cardiac operations has been well established.5-26 In recognition of the increasing clinical applications and use of Intraoperative TEE, the American Society of Echocardiography (ASE) established the Council for Intraoperative Echocardiography in 1993 to address issues related to the use of Echocardiography in the operating room. In June 1997, the Council board decided to create a set of guidelines for performing a comprehensive TEE examination composed of a set of anatomically directed cross-sectional views. The Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography has endorsed these guidelines and standards of nomenclature for the various anatomically directed cross-sectional views of the comprehensive TEE examination. This document, therefore, is the collective result of an effort that represents the consensus view of both anesthesiologists and cardiologists who have extensive experience in Intraoperative Echocardiography. The writing group has several goals in mind in creating these guidelines. The first is to facilitate training in Intraoperative TEE by providing a framework in which to develop the necessary knowledge and skills. The guidelines may also enhance quality improvement by providing a means to assess the technical quality and completeness of individual studies. More consistent acquisition and description of Intraoperative echocardiographic data will facilitate communication between centers and provide a basis for multicenter investigations. In recognition of the increasing availability and advantages of digital image storage, the guidelines define a set of cross-sectional views and nomenclature that constitute a comprehensive Intraoperative TEE examination that could be stored in a digital format. These guidelines will encourage industry to develop Echocardiography systems that allow quick and easy acquisition, labeling, and storage of images in the operating room, as well as a simple mechanism for side-by-side comparison of views made at different times. ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination: Recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography
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Intraoperative Echocardiography is indicated in high risk coronary artery bypass grafting
The Annals of Thoracic Surgery, 1997Co-Authors: Robert M Savage, Bruce W Lytle, Solomon Aronson, William J Stewart, Jose L Navia, Michael G Licina, Norman J Starr, Floyd D LoopAbstract:Background. Intraoperative Echocardiography is a valuable monitoring and diagnostic technology used in cardiac surgery. This reports our clinical study of the usefulness of Intraoperative Echocardiography to both surgeons and anesthesiologists for high-risk coronary artery bypass grafting. Methods. From March to November 1995, 82 consecutive high-risk patients undergoing coronary artery bypass grafting were studied in a four-stage protocol to determine the efficacy of Intraoperative Echocardiography in management planning. Alterations in surgical and anesthetic/hemodynamic management initiated by Intraoperative Echocardiography findings were documented in addition to perioperative morbidity and mortality. Results. Intraoperative Echocardiography initiated at least one major surgical management alteration in 27 patients (33%) and at least one major anesthetic/hemodynamic change in 42 (51%). Mortality and the rate of myocardial infarction in this consecutive high-risk study population using Intraoperative Echocardiography and in a similar group of patients without the use of Intraoperative Echocardiography was 1.2% versus 3.8% (not significant) and 1.2% versus 3.5% (not significant), respectively. Conclusions. We conclude that when all of the isolated diagnostic and monitoring applications of perioperative Echocardiography are routinely and systematically performed together, it is a safe and viable tool that significantly affects the decision-making process in the Intraoperative care of high-risk patients undergoing primary isolated coronary artery bypass grafting and may contribute to the optimal care of these patients.
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do patients with less than echo perfect results from mitral valve repair by Intraoperative Echocardiography have a different outcome
Circulation, 1993Co-Authors: James Fix, Delos M. Cosgrove, Robert M Savage, Loretta R Isada, David P Miller, James M Blum, William J StewartAbstract:Background. Not all valve repairs for mitral regurgition (MR) have a perfect result, with no MR on postpump Intraoperative Echocardiography. Although more than 2+ MR by postpump Echocardiography has led to second pump runs for further surgery in 6% to 8% of our patients, those left with 1+ or 2+ MR, traditionally an acceptable result, have not previously been evaluated for clinical outcome. Methods and Results. Among 530 patients undergoing mitral repair during 1987 to 1989, 76 patients with 1+ or 2+ MR by postpump Intraoperative Echocardiography were compared with 76 patients who had equivalent age, sex, left ventricular function, and concominant surgery butwho had no MR by postpump echo
Hartzell V Schaff - One of the best experts on this subject based on the ideXlab platform.
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adult Intraoperative Echocardiography a comprehensive review of current practice
Journal of The American Society of Echocardiography, 2020Co-Authors: Jeremy J Thaden, Joseph F Malouf, Kent H Rehfeldt, Elena Ashikhmina, Gabor Bagameri, Maurice Enriquezsarano, John M Stulak, Hartzell V Schaff, Hector I MichelenaAbstract:Intraoperative transesophageal Echocardiography is a mature imaging modality and critical component of contemporary heart surgery, in which it plays a key role in surgical planning, determination of cardiac chamber filling and function early after cardiopulmonary bypass, and timely assessment of surgical interventions. Intraoperative transesophageal Echocardiography affords the unique opportunity to correct suboptimal surgical results before leaving the operating room. Herein, the authors provide a comprehensive review of their institution's experience with Intraoperative transesophageal Echocardiography, emphasizing a practical assessment of commonly encountered noncongenital surgical heart lesions in adults, anticipation of potential surgical complications, and imaging approaches to facilitate timely surgical correction of unsatisfactory results.
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Intraoperative Echocardiography in valvular heart disease an evidence based appraisal
Mayo Clinic Proceedings, 2010Co-Authors: Hector I Michelena, Hartzell V Schaff, Martin D Abel, Rakesh M Suri, William K Freeman, Roger L Click, Thoralf M Sundt, Maurice EnriquezsaranoAbstract:Intraoperative (IO) transesophageal Echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. We found no randomized trials or studies with control groups assessing the impact of IOTEE in VHD surgery. Pooled analysis of 8 observational studies including 15,540 patients showed an average incidence of 11% for prebypass surgical changes and 4% for second pump runs, suggesting that patients undergoing VHD surgery may benefit significantly from IOTEE, particularly from postcardiopulmonary bypass IOTEE in aortic repair and mitral repair and replacement, but less so in isolated aortic replacement. Further available indirect evidence was satisfactory in the test accuracy and surgical quality control aspects, with low complication rates for IOTEE. The data supporting EAU included 12,687 patients in 2 prospective randomized studies and 4 nonrandomized, controlled studies, producing inconsistent outcome-related results. Despite low-quality scientific evidence supporting IOTEE in VHD surgery, we conclude that indirect evidence supporting its use is satisfactory and suggests that IOTEE may offer considerable benefit in valvular repairs and mitral replacements. The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications.
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systolic anterior motion after mitral valve repair is surgical intervention necessary
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Morgan L Brown, Martin D Abel, Roger L Click, Thoralf M Sundt, Ronald G Morford, Joseph A Dearani, Thomas A Orszulak, Hartzell V SchaffAbstract:Objective The natural history and management of patients with systolic anterior motion after mitral valve repair are uncertain. Methods We performed a retrospective chart review and survey follow-up of all patients in whom systolic anterior motion developed Intraoperatively after mitral valve repair. Results From January 1993 to December 2002, mitral valve repair was performed in 2076 patients, and in 174 cases (8.4%) systolic anterior motion was identified on Intraoperative Echocardiography. These patients form the study group. Initially, patients were managed with a combination of β-blockade, vasoconstriction with phenylephrine, and/or intravascular volume expansion. Four patients had revision of repair because of persistent systolic anterior motion, and 3 additional patients had revision of repair because of mitral regurgitation from other causes. The median follow-up of the remaining 167 patients was 5.4 years (range 0-13.2 years). There were 2 late reoperations, but none were caused by systolic anterior motion or left ventricular outflow tract obstruction. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV. Echocardiograms were available for review in 93 patients at a median interval of 5.4 years (range 0.2-12.2 years); 13 patients had systolic anterior motion, and 4 patients had systolic anterior motion with left ventricular outflow tract obstruction. Conclusions In this experience, most cases of systolic anterior motion resolved with conservative measures including β-blockade, vasoconstriction, and fluid administration. Persistent systolic anterior motion with left ventricular outflow tract obstruction was documented in 2.3% of patients who had early systolic anterior motion, but late reoperation was not required. Furthermore, the clinical outcomes of patients with systolic anterior motion are comparable to the current norms for mitral valve repair. Ninety percent of patients were in New York Heart Association class I, 7% were in class II, and 3% were in class III or IV.