Cibenzoline attenuates systolic anterior motion of the mitral valve after mitral valvoplasty

We report a patient in whom severe hemodynamic instability occurring after mitral valvoplasty (MVP) was successfully treated with cibenzoline. Left ventricular outflow tract obstruction (LVOTO) with mitral regurgitation (MR) resulting from the systolic anterior motion (SAM) of the mitral valve that occurs after MVP often leads to hemodynamic collapse. Patients who develop SAM after MVP have been managed with intravenous volume loading, reduction/discontinuation of inotropic drugs, and with increased afterload, but these strategies were often ineffective. Cibenzoline decreased myocardial contraction, attenuated SAM, and improved hemodynamics in our patient. We recommend that cibenzoline be administered before further surgical manipulation is considered for patients who develop SAM after MVP.     

Severe mitral systolic anterior motion complicating aortic valve replacement

This case illustrates a severe dynamic left ventricular outflow obstruction after aortic valve replacement (AVR). This phenomenon is little recognised but probably occurs more frequently than appreciated, and should be considered when managing patients with severe haemodynamic instability after AVR. The possible mechanisms and treatment are discussed.     

A short-acting beta-blocker,landiolol, attenuates systolic anterior motion of the mitral valve after mitral valve annuloplasty

Here, we describe three patients with severe hemodynamic instability after mitral valve annuloplasty (MVP) who were treated successfully using a new ultra-short-acting beta-blocker, landiolol hydrochloride. When systolic anterior motion (SAM) of the mitral valve occurs after MVP, left ventricular outflow tract obstruction (LVOTO) and mitral regurgitation (MR) often lead to hemodynamic collapse. Treatment of SAM is very difficult, and transfusion, or the reduction/discontinuation of catecholamine or vasopressor administration, is often ineffective. In our three patients, landiolol hydrochloride decreased the heart rate, markedly attenuated SAM, and improved the hemodynamics. We recommend that landiolol be administered before further surgical manipulation is considered in patients with SAM after MVP.     

Modern management of systolic anterior motion of the mitral valve

Systolic anterior motion (SAM) of the mitral valve (MV) can be a life-threatening condition. The SAM can result in severe left ventricular outflow tract obstruction and/or mitral regurgitation and is associated with an up to 20% risk of sudden death (which is substantially lower in hypertrophic cardiomyopathy (HCM)). The mechanisms of SAM are complex and depend on the functional status of the ventricle. The SAM can occur in the normal population, but is typically observed in patients with HCM or following MV repair. Echocardiography (2D, 3D and stress) has a central diagnostic role as the application of echocardiographic SAM predictors allows the incorporation of prevention techniques during surgery and post-operative SAM assessment. Cardiac magnetic resonance imaging has a special role in understanding the dynamic nature of SAM, especially in anatomically atypical hearts (including HCM). This article describes what the clinician needs to know about SAM ranging from pathophysiological mechanisms and imaging modalities to conservative (medical) and surgical approaches and their respective outcomes. A stepwise approach is advocated consisting of medical therapy, followed by aggressive volume loading and beta-adrenoceptor blockade. Surgery is the final option. The correct choice of surgical technique requires an understanding of the anatomical substrate of SAM.     

Systolic anterior motion after mitral valve repair: predicting factors and management

Purpose  

The aim of this study was to determine the mechanism of systolic anterior motion (SAM) after mitral valve (MV) repair by analyzing the clinical data of patients with MV repair.     

Management of intraoperative systolic anterior motion of the mitral valve after valve plasty: a case report

We report a case of intraoperative systolic anterior motion (SAM) of the mitral valve after mitral valve plasty (MVP). A 53-year-old man underwent MVP for mitral regurgitation (MR). MVP was carried out uneventfully. We weaned the patient from cardiopulmonary bypass (CPB) with continuous administration of catecholamines and a vasodilator. However, after the weaning from CPB, transesophageal echocardiography (TEE) detected moderate MR with left ventricular outflow tract obstruction (LVOTO) due to SAM. LVOTO and SAM gradually disappeared after the reduction of catecholamines and volume loading. He was transferred to the intensive care unit postoperatively and extubated 18 hours after operation. Transthoracic echocardiography after operation revealed disappearance of MR. He was discharged from the hospital on postoperative day 15 without complications. We successfully managed MR with LVOTO due to SAM by reduction of catecholamines and volume loading.     

Importance of anesthetic management for the patients with systolic anterior motion after mitral valve plasty

Systolic anterior motion (SAM) after mitral valve plasty (MVP) occurs at an incidence of 1 to 4%. The management is related to this condition. Three patients developed SAM just after MVP. In the first patient, a 51-year-old man, volume loading and methoxamine were employed, which elevated arterial pressure, but led to a severer catastrophe. This suggested the indication of mitral valve replacement to the surgeons. The second patient, a 75-year-old woman, underwent re-annuloplasty after the first MVP because of incomplete correction. Before the separation from the second CPB, continuous dopamine infusion was started because we feared that the long CPB time would have impaired LV function. The TEE showed the catastrophe, but it disappeared just after the discontinuation of the dopamine infusion and the administration of propranolol and norepinephrine. The last patient was a 72-year-old woman. For the catastrophe, propranolol was given and an immediate improvement followed with TEE showing no evidence of the catastrophe. The goal for anesthetic management of the catastrophe after MVP is to decrease the hyperdynamic ventricular contraction. We managed SAM by volume loading and discontinuation of beta-stimulants and/or administration of beta-blockers.     

Myectomy as an alternative solution for systolic anterior motion in a patient who underwent mitral valve repair

Systolic anterior motion (SAM) of the mitral apparatus is a relatively frequent complication of mitral valve repair. When significant SAM persists despite intraoperative medical therapies, a second repair is generally required. We describe a rare case of SAM due to a hypertrophic septum in a patient who underwent mitral valve repair, with no preoperative obstruction of the left ventricular outflow tract. The present case of SAM was successfully treated only with transaortic septal myectomy. Therefore, myectomy might be considered as an alternative solution for SAM that is suspected to be caused by a hypertrophic septum after mitral valve repair.