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.