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. Author manuscript; available in PMC: 2023 Jun 28.
Published in final edited form as: JACC Adv. 2023 Apr 26;2(3):100308. doi: 10.1016/j.jacadv.2023.100308

CENTRAL ILLUSTRATION. The Mitral Valve Residual Leaflet in Hypertrophic Cardiomyopathy.

CENTRAL ILLUSTRATION

In obstructive hypertrophic cardiomyopathy, the residual leaflet extends beyond the coaptation point and is susceptible to flow drag forces that push it anteriorly, driving outflow tract obstruction (A). Our results suggest a hypothetical mechanism contributing to leaflet elongation: a feed-forward cycle in which chronic hydrodynamic forces over time cause myxoid changes that make the leaflet more susceptible to hydrodynamic elongation (B). Pushing hydrodynamic force on the residual leaflet (white arrows). Histologic analysis of resected residual leaflets showed structural disorganization with expanded spongiosa featuring increased fragmented elastic fibers, attenuated collagenous fibrosa, and superimposed collagenous tissue overlying the valve (C).