To Order:

This image shows systolic anterior mitral valve motion (SAM) (arrows).  The mitral valve is pulled up into the left ventricular outflow tract during systole.  SAM can be created by a venturi effect as high flow velocity in a narrowed outflow tract drags the leaflet upwards.  It may also be produced by abnormal alignment of the papillary muscles resulting in displacement of the mitral leaflet during systole.  Regardless of the cause, its presence  implies outflow obstruction.  Below are more examples of SAM on m-mode and 2D images. 

1	Maron B, McKenna W. American College of Cardiology / European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. J Am Col Cardiol 2003;43.
2	Nagueh S, Mahmarian J. Noninvasive cardiac imaging in patients with hypertrophic cardiomyopathy. J Am Col Cardiol 2006;48:2410-2422.
3	Nishimura R, Ommen S. Hypertrophic cardiomyopathy: the search for obstruction. Circ 2006;114:2200-2202.
4	Kovacic J, Muller D. Hypertrophic cardiomyopathy: state of the art review, with focus on the management of outflow obstruction. Int Med J 2003;33:521-529.
5	Doi T, Ayukawa H, Hoshiyama Y, et al. Systolic anterior motion (SAM) of the posterior mitral leaflet: Left ventricular outflow tract obstruction in a patient without left ventricular hypertrophy. Int J Cardiol 2006;109:271-272.
6	Yoerger D, Weyman A. Hypertrophic obstructive cardiomyopathy: mechanism of obstruction and response to therapy. Cardiovasc Med 2003;4:199-215.



Arrows show the systolic anterior mitral valve motion (SAM).  Use the left ventricular wall motion to help you identify the systolic time period.  VS = ventricular septum, MV = mitral valve, LVW = left ventricular wall, RV = right ventricle, LV = left ventricle, AO = aorta, LA = left atrium, MVd = mitral valve in diastole