The Systolic Anterior Motion After Mitral Valve Repair: A Narrative Review of Current Therapeutic Algorithms in the Operating Room.

Background and Aims: Systolic anterior motion (SAM) represents the displacement of the anterior mitral leaflet during ventricular systole toward the interventricular septum, causing an obstruction of the outflow tract. Most of the published data regards the primary SAM that is associated with hypertrophic cardiomyopathy. This review was focused on the management of SAM that occurs after mitral valve repair. Methods: To perform an update about the SAM occurring after mitral valve repair, data published in the last 15 years (2010-2025) were revised. Results: Out of the 354 publications that deal with SAM, 97 representative original papers matched our inclusion criteria: papers about the postoperative SAM and the description of SAM treatment. Although SAM can be successfully identified postoperatively, the paper highlights the importance of transesophageal echocardiography, in the operating room, as a diagnostic tool. The review also evaluates the treatment approaches, from conservative to surgical methods, and present them using representative graphs. It was showed that, postoperatively, conservative treatment is an option for patients with "negative SAM tolerance test." When necessary, the type of surgical intervention should take into consideration the particularities of the mitral ring, leaflets, subvalvular apparatus, the mitral coaptation line, and the pre-existing diseases. Conclusion: For proper management of post-operative SAM, the implementation of an in-house treatment algorithm should be established before the patient leaves the operating room.