Intravenous Beta-blockade Therapy for Systolic Anterior Motion-induced Mitral Insufficiency Following Mitral Valve Plasty : A Case Report

Mitral valve plasty (MVP) was performed on a 51-year-old man with moderate mitral regurgitation (MR) by posterior leaflet prolapse. In the diagnosis using preoperative transthoracic echocardiography, the left ventricular wall had normal motion, and no left ventricular outflow tract (LVOT) obstruction was observed. By using transesophageal echocardiography (TEE) after the induction of anesthesia, similar findings and mild aortic regurgitation were confirmed. After MVP proceeded as planned, the patient was weaned from cardiopulmonary bypass (CPB) with no catecholamine (CA). During weaning from CPB, severe MR appeared. We returned to CPB, and a little procedure for the tip of posterior leaflet was undertaken. During weaning from the second CPB, we observed moderate MR and LVOT mosaic in the TEE. We detected systolic anterior motion (SAM). We managed SAM by propranolol, landiolol chloride, volume loading, and administration of norepinephrine. SAM gradually disappeared, and MR became trivial grade at the end of the operation. As of one year after the surgery, the patient has had no MR or SAM.