We describe an approach to address the left ventricular outflow tract obstruction (LVOTO) in Hypertrophic Obstructive Cardiomyopathy (HOCM) with concomitant systolic anterior motion of mitral valve. This approach has two main purposes: to enlarge the LVOT through a "moderate" myectomy and to "discipline" the excessive movement of the mitral valve anterior leaflet through paradoxical chords implantation and, similarly, the papillary muscle too, if necessary, hanging paradoxical chords between the papillary muscle itself and the posterior mitral annulus.
Kassem S, Roberto M, Ricciardi G, Alamanni F. Paradoxical Neochords to Treat Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy. Ann Thorac Surg 2018 Sep 4. pii: S0003-4975(18)31186-X. doi: 10.1016/j.athoracsur.2018.07.021. [Epub ahead of print]