title: Medical Management (β Blocker ± Disopyramide) of Left Ventricular Outflow Gradient Secondary to Systolic Anterior Motion of the Mitral Valve After Repair.
abstract: Systolic anterior motion of the mitral valve (SAM) occurs intraoperatively after mitral valve repair (MVRr) in up to 14% of cases and typically resolves in the operating room with conservative measures. Less commonly SAM may also occur in the early or late postoperative period. The clinical course and optimal management of such cases is poorly defined, but reoperation is common. We describe our experience using disopyramide to successfully treat postoperative SAM refractory to beta blockade. Seven patients were retrospectively identified with mitral valve prolapse who underwent MVRr from 2003 to 2015 and were found during follow-up to have severe SAM with a left ventricular outflow tract (LVOT) gradient not observed intraoperatively. All 7 patients were successfully managed medically. In 5 cases, SAM persisted even after maximization of beta blockade, and the addition of disopyramide led to significant improvement or resolution of SAM, the LVOT gradient, and mitral regurgitation. The postoperative LVOT gradient initially exceeded 30 mm Hg in 6 of 7 patients. In 2 patients, the LVOT gradient exceeded 100 mm Hg, and both were managed medically with disopyramide with complete resolution of SAM. In conclusion, SAM after MVRr typically follows a benign clinical course and can be managed medically in most cases. When an initial treatment strategy of beta blockade is insufficient, the addition of disopyramide can effectively alleviate and terminate this condition and should be considered before reoperation.
authors: Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: devinwkehl@gmail.com.
authors: Devin W
authors: DW
authors: Kehl
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Florian
authors: F
authors: Rader
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Charles
authors: C
authors: Pollick
authors: Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Alfredo
authors: A
authors: Trento
authors: Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: Robert.Siegel@cshs.org.
authors: Robert J
authors: RJ
authors: Siegel
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D004206:Disopyramide / Q000627:therapeutic use*; D018618:Echocardiography, Doppler, Color; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008945:Mitral Valve Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012189:Retrospective Studies; D013599:Systole; D061567:Voltage-Gated Sodium Channel Blockers / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D061567:Voltage-Gated Sodium Channel Blockers; D004206:Disopyramide