[Case in which landiolol hydrochloride improved left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve following mitral valve plasty].

Abstract	We report a case of left ventricular outflow tract (LVOT) obstruction caused by systolic anterior motion of the mitral valve (SAM) following mitral valve plasity (MVP). A 65-year-old man underwent mitral valve plasty for grade III mitral valve regurgitation. The plasty was done smoothly and the patient was weaned from cardiopulmonary bypass successfully with continuous dobutamine infusion. However, about 30 minutes after the weaning, severe cardiovascular collapse developed. Inotropic agent, such as dobutamine, ephedrine, or calcium hydrochloride was not effective. Trans-esophageal echocardiography (TEE) showed severe mitral valve regurgitation with LVOT obstruction due to SAM. The collapse was successfully treated with volume loading and a small amount of a beta1-adrenergic antagonist, landiolol hydrochloride. We conclude that acute LVOT obstruction with SAM could develop following MVP. TEE was a much useful tool for early diagnosis and landiolol hydrochloride would be a notable agent for nonsurgical treatment of LVOT obstruction with SAM.
Authors	Tetsuya Kushikata, Hiroshi Hashimoto, Eiji Hashiba, Kozo Fukui, Kazuo Itoh, Kazuyoshi Hirota
Journal	Masui. The Japanese journal of anesthesiology (Masui) Vol. 55 Issue 1 Pg. 96-9 (Jan 2006) ISSN: 0021-4892 [Print] Japan
PMID	16440719 (Publication Type: Case Reports, English Abstract, Journal Article)
Chemical References	Adrenergic beta-Antagonists Morpholines landiolol Urea
Topics	Adrenergic beta-Antagonists (therapeutic use) Aged Heart Valve Prosthesis Implantation Humans Male Mitral Valve (surgery) Mitral Valve Insufficiency (complications, surgery) Morpholines (therapeutic use) Postoperative Complications (drug therapy, etiology) Shock (drug therapy, etiology) Systole Treatment Outcome Urea (analogs & derivatives, therapeutic use) Ventricular Outflow Obstruction (drug therapy, etiology)

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