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Validation of a decision-making strategy for systolic anterior motion following mitral valve repair
- Source :
- Annals of Cardiac Anaesthesia, Vol 14, Iss 2, Pp 85-90 (2011)
- Publication Year :
- 2011
-
Abstract
- "Low cardiac output syndrome and hypotension are dreadful consequences of systolic anterior motion (SAM) after a mitral valve (MV) repair. The management of SAM in the operating room remains controversial. We validate a recently suggested two-step management method and classification of this complication. This was a teaching hospital-based observational study. We validated a novel two-step conservative management method, consisting in intravascular volume expansion and discontinuation of inotropic drugs (step 1), and increasing the afterload by ascending aorta manual compression while administering esmolol e.v. (step 2). We also validate a novel classification of SAM: easy-to-revert (responding to step 1), difficult-to-revert (responding to step 2), or persistent. Fifty patients had an easy-to-revert while 26 had a difficult-to-revert SAM; 4 patients had a persistent condition (promptly diagnosed through our decisional algorithm) and underwent an immediate second pump run to repeat the mitral repair surgery. We confirmed that SAM after a repair of a degenerative MV is common and validated a simple two-step conservative management method that allows to clearly identify those few patients who require immediate surgical revision."
- Subjects :
- Male
lcsh:Diseases of the circulatory (Cardiovascular) system
medicine.medical_treatment
systolic anterior motion
Plasma Substitutes
Propanolamines
Hypothermia, Induced
Mitral valve
Intravascular volume status
Medicine
Heart Valve Prosthesis Implantation
Cardiopulmonary Bypass
mitral repair
Mitral Valve Insufficiency
Heart
General Medicine
Middle Aged
Esmolol
Cardiac surgery
medicine.anatomical_structure
Cardiac anesthesia
Heart Valve Prosthesis
Cardiology
Heart Arrest, Induced
Mitral Valve
Female
Cardiology and Cardiovascular Medicine
cardiac surgery
medicine.drug
Adult
Reoperation
medicine.medical_specialty
Systole
Adrenergic beta-Antagonists
esmolol
Perioperative Care
lcsh:RD78.3-87.3
Afterload
Internal medicine
medicine.artery
Monitoring, Intraoperative
Ascending aorta
Humans
Minimally Invasive Surgical Procedures
Aged
Mitral valve repair
business.industry
Reproducibility of Results
Sternotomy
Surgery
Anesthesiology and Pain Medicine
lcsh:Anesthesiology
lcsh:RC666-701
business
Echocardiography, Transesophageal
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Annals of Cardiac Anaesthesia, Vol 14, Iss 2, Pp 85-90 (2011)
- Accession number :
- edsair.doi.dedup.....31798b235b28e53b3953abaffea51a6c