Correction of intraoperative diastolic myocardial dysfunction with nifedipine.

We report the case of a 62-year-old man with severe aortic stenosis and hypertrophic cardiomyopathy, who could not be weaned from cardiopulmonary bypass after aortic valve replacement until buccal administration of the calcium-blocking agent nifedipine led to achievement of adequate hemodynamics. These observations demonstrate the importance of diastolic dysfunction in patients with hypertrophic cardiomyopathy, and suggest an important peri- and intraoperative role for calcium-blocking agents in their management. Recent hemodynamic studies have shown the importance of diastolic myocardial dysfunction in patients with hypertrophic cardiomyopathy, and demonstrated that calcium-blocking agents may enhance myocardial performance by reducing this dysfunction (Goodwin, 1982; Lorell et al., 1980, 1982; Sanderson et al., 1977). Although this new class of drugs has been increasingly used as an adjunct to cardioplegia, there is little information thus far on their application as treatment of intraoperative diastolic abnormalities. We report the case of a 62-year-old man with severe aortic stenosis and hypertrophic cardiomyopathy, who could not be weaned from cardiopulmonary bypass after aortic valve replacement until buccal administration of the calcium-blocking agent nifedipine led to an increase in cardiac output and blood pressure.