Omae Takeshi, Matsunaga Akira, Imakiire Naka, Sakata Ryuzo, Kanmura Yuichi
Department of Anesthesiology and Critical Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
J Anesth. 2009;23(3):413-6. doi: 10.1007/s00540-009-0752-5. Epub 2009 Aug 14.
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.
我们报告了一例二尖瓣成形术（MVP）后出现严重血流动力学不稳定的患者，其通过西苯唑啉治疗成功。MVP后二尖瓣收缩期前向运动（SAM）导致的伴有二尖瓣反流（MR）的左心室流出道梗阻（LVOTO）常导致血流动力学崩溃。MVP后发生SAM的患者采用静脉补液、减少/停用正性肌力药物以及增加后负荷进行处理，但这些策略往往无效。西苯唑啉降低了心肌收缩力，减轻了SAM，并改善了我们这位患者的血流动力学。我们建议，对于MVP后发生SAM的患者，在考虑进一步手术干预之前先给予西苯唑啉治疗。
