title: Cibenzoline attenuates systolic anterior motion of the mitral valve after mitral valvoplasty.
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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Omae
authors.forename: Akira
authors.initials: A
authors.lastname: Matsunaga
authors.forename: Naka
authors.initials: N
authors.lastname: Imakiire
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Sakata
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kanmura
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D007431:Intraoperative Complications / Q000188:drug therapy; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012769:Shock / Q000188:drug therapy / Q000209:etiology; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery
chemical_list: D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; C032151:cifenline
references.citation: J Am Coll Cardiol. 1992 Sep;20(3):599-609
references.pmid: 1512339
references.citation: Cardiovasc Drugs Ther. 2001 Sep;15(5):459-65
references.pmid: 11855665
references.citation: Br J Pharmacol. 1982 Mar;75(3):469-78
references.pmid: 7066601
references.citation: J Anesth. 2008;22(3):286-9
references.pmid: 18685936
references.citation: Ann Thorac Surg. 2006 Dec;82(6):2096-100; discussion 2101
references.pmid: 17126117
references.citation: Anesth Analg. 2005 Jul;101(1):2-8, table of contents
references.pmid: 15976197
references.citation: Circulation. 2003 Sep 2;108(9):1146-62
references.pmid: 12952829
references.citation: Br J Pharmacol. 1983 Jul;79(3):701-9
references.pmid: 6652350
references.citation: J Cardiovasc Pharmacol. 1990 Feb;15(2):308-16
references.pmid: 1689428
references.citation: Circulation. 1993 Nov;88(5 Pt 2):II24-9
references.pmid: 8222161
references.citation: Circulation. 1993 Nov;88(5 Pt 2):II30-4
references.pmid: 8222170
references.citation: J Thorac Cardiovasc Surg. 1983 Oct;86(4):608-15
references.pmid: 6604846
references.citation: J Thorac Cardiovasc Surg. 2007 Jan;133(1):136-43
references.pmid: 17198799