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An unusual cause of systolic anterior motion of the mitral valve.

PATIENTS who have concentric left ventricular hypertrophy (LVH), often as part of a cardiomyopathy associated with hypovolemia, pericardial effusion, or anemia, at times may develop dynamic left ventricular outflow tract (LVOT) obstruction. Because this disorder mimics left ventricular failure, accurate and timely diagnosis is imperative. Therapy for this disorder is the opposite of that for a failing heart; standard heart failure therapy (vasodilation and increased inotropy) worsens this disease process. Intraoperative transesophageal echocardiography (TEE) allows for accurate diagnosis of LVOT obstruction because of systolic anterior motion (SAM) of the mitral valve. Accurate diagnosis allows for proper therapy. A case is presented of a patient who had coronary artery disease and developed dynamic LVOT obstruction 8 hours after undergoing coronary artery bypass graft surgery.