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.