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Cibenzoline attenuates systolic anterior motion of the mitral valve after mitral valvoplasty

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Abstract

We report a patient in whom severe hemodynamic instability occurring after mitral valvoplasty (MVP) was successfully treated with cibenzoline. Left ventricular outflow tract obstruction (LVOTO) with mitral regurgitation (MR) resulting from the systolic anterior motion (SAM) of the mitral valve that occurs after MVP often leads to hemodynamic collapse. Patients who develop SAM after MVP have been managed with intravenous volume loading, reduction/discontinuation of inotropic drugs, and with increased afterload, but these strategies were often ineffective. Cibenzoline decreased myocardial contraction, attenuated SAM, and improved hemodynamics in our patient. We recommend that cibenzoline be administered before further surgical manipulation is considered for patients who develop SAM after MVP.

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References

  1. Omae T, Tsuneyoshi I, Higashi A, Matsunaga A, Sakata R, Kanmura Y. A short-acting beta-blocker, landiolol, attenuates systolic anterior motion of the mitral valve after mitral valve annuloplasty. J Anesth. 2008;22:286–289.

    Article  PubMed  Google Scholar 

  2. Hashiba E, Fukui K, Itoh K, Hirota K. A case in which landiolol hydrochloride improved left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve following the mitral valve plasty (in Japanese with English abstract). Masui (Jpn J Anesthesiol). 2006;55:96–99.

    Google Scholar 

  3. Hamada M, Shigematsu Y, Ikeda S, Hara Y, Okayama H, Kodama K, Ochi T, Hiwada K. Class Ia antiarrhythmic drug cibenzoline: a new approach to the medical treatment of hypertrophic obstructive cardiomyopathy. Circulation. 1997;96:1520–1524.

    PubMed  CAS  Google Scholar 

  4. Malkowski MJ, Boudoulas H, Wooley CF, Guo R, Pearson AC, Gray PG. Spectrum of structural abnormalities in floppy mitral valve echocardiographic evaluation. Am Heart J. 1996;132:145–151.

    Article  PubMed  CAS  Google Scholar 

  5. Maslow AD, Regan MM, Haering JM, Johnson RG, Levine RA. Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease. J Am Coll Cardiol. 1999;34:2096–2104.

    Article  PubMed  CAS  Google Scholar 

  6. Omae T, Kakihana Y, Mastunaga A, Tsuneyoshi I, Kawasaki K, Kanmura Y, Sakata R. Hemodynamic changes during off-pump mitral regurgitation: improvement with milrinone. Anesth Analg. 2005;101:2–8.

    Article  PubMed  Google Scholar 

  7. Jebara VA, Mihaileanu S, Acar C, Brizard C, Grare P, Latremouille C, Chauvaud S, Fabiani JN, Deloche A, Carpentier A. Left ventricular outflow tract obstruction after mitral valve repair. Results of the sliding leaflet technique. Circulation. 1993;88:1130–1134.

    Google Scholar 

  8. Adams DH, Anyanwu AC, Rahmanian PB, Abascal V, Salzberg SP, Filsoufi F. Large annuloplasty rings facilitate mitral valve repair in Barlow’s disease. Ann Thorac Surg. 2006;82:2096–2100.

    Article  PubMed  Google Scholar 

  9. Brown ML, Abel MD, Click RL, Morford RG, Dearani JA, Sundt TM, Orszulak TA, Schaff HV. Systolic anterior motion after mitral valve repair: is surgical intervention necessary? J Thorac Cardiovasc Surg. 2007;133:136–143.

    Article  PubMed  Google Scholar 

  10. Freeman WK, Schaff HV, Khandheria BK, Oh JK, Orszulak TA, Abel MD, Seward JB, Tajik AJ. Intraoperative evaluation of mitral valve regurgitation and repair by transesophageal echocardiography: incidence and significance of systolic anterior motion. J Am Coll Cardiol. 1992;20:599–609.

    Article  PubMed  CAS  Google Scholar 

  11. Morford RG, Abel MD, Schaff HV, Click RL. Systolic anterior motion of the mitral valve after surgical repair: incidence and natural history (abstract). J Am Coll Cardiol. 2003;41:503A.

    Article  Google Scholar 

  12. Lee KS, Stewart WJ, Lever HM, Underwood PL, Cosgrove DM. Mechanism of outflow tract obstruction causing failed mitral valve repair. Anterior displacement of leaflet coaptation. Circulation. 1993;88:1124–1129.

    Google Scholar 

  13. Engelman RM, Haag B, Lemeshow S, Angelo A, Rousou JH. Mechanism of plasma catecholamine increases during coronary artery bypass and valve procedures. J Thorac Cardiovasc Surg. 1983;86:608–615.

    PubMed  CAS  Google Scholar 

  14. Cheitlin MD, Armstrong WF, Aurigemma GP, Beller GA, Bierman FZ, Davis JL, Douglas PS, Faxon DP, Gillam LD, Kimball TR, Kussmaul WG, Pearlman AS, Philbrick JT, Rakowski H, Thys DM, Antman EM, Smith SC, Alpert JS, Gregoratos G, Anderson JL, Hiratzka LF, Hunt SA, Fuster V, Jacobs AK, Gibbons RJ, Russell RO. American College of Cardiology; American Heart Association; American Society of Echocardiography. ACC/AHA/ASE 2003 guideline update or the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. 2003;108:1146–1162.

    Article  PubMed  Google Scholar 

  15. Miller JS, Vaughan Williams EM. Pharmacological mapping of regional effects in the rabbit heart of some new antiarrhythmic drugs. Br J Pharmacol. 1983;79:701–709.

    Google Scholar 

  16. Miller JS, Vaughan Williams EM. Effects on rabbit nodal, atrial, ventricular and Purkinje cell potentials of a new antiarrhythmic drug cibenzoline, which protects against action potential shorting in hypoxia. Br J Pharmacol. 1982;75:469–478.

    Google Scholar 

  17. Kondo I, Mizushige K, Nozaki S, Iwado Y, Masugata H, Kohno M, Matsuo H. Effect of cibenzoline, a class Ia antiarrhythmic agent, on left ventricular diastolic function in hypertrophic cardiomyopathy. Cardiovasc Drugs Ther. 2001;15:459–465.

    Article  PubMed  CAS  Google Scholar 

  18. Cazes M, Chassaing C, Martinet M, Cloarec A, Provost D, Boucher M, Duchêne-Marullaz P. Comparison of anticholinergic effects of cibenzoline, disopyramide, and atropine. J Cardiovasc Pharmacol. 1990;15:308–316.

    Article  PubMed  CAS  Google Scholar 

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Omae, T., Matsunaga, A., Imakiire, N. et al. Cibenzoline attenuates systolic anterior motion of the mitral valve after mitral valvoplasty. J Anesth 23, 413–416 (2009). https://doi.org/10.1007/s00540-009-0752-5

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  • DOI: https://doi.org/10.1007/s00540-009-0752-5

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