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Ann Card Anaesth ; 2011 May; 14(2): 85-90
Article Dans Anglais | IMSEAR | ID: sea-139579

Résumé

Low cardiac output syndrome and hypotension are dreadful consequences of systolic anterior motion (SAM) after a mitral valve (MV) repair. The management of SAM in the operating room remains controversial. We validate a recently suggested two-step management method and classification of this complication. This was a teaching hospital-based observational study. We validated a novel two-step conservative management method, consisting in intravascular volume expansion and discontinuation of inotropic drugs (step 1), and increasing the afterload by ascending aorta manual compression while administering esmolol e.v. (step 2). We also validate a novel classification of SAM: easy-to-revert (responding to step 1), difficult-to-revert (responding to step 2), or persistent. Fifty patients had an easy-to-revert while 26 had a difficult-to-revert SAM; 4 patients had a persistent condition (promptly diagnosed through our decisional algorithm) and underwent an immediate second pump run to repeat the mitral repair surgery. We confirmed that SAM after a repair of a degenerative MV is common and validated a simple two-step conservative management method that allows to clearly identify those few patients who require immediate surgical revision.


Sujets)
Antagonistes bêta-adrénergiques/usage thérapeutique , Adulte , Sujet âgé , Pontage cardiopulmonaire , Échocardiographie transoesophagienne , Femelle , Coeur/physiologie , Arrêt cardiaque provoqué , Prothèse valvulaire cardiaque , Implantation de valve prothétique cardiaque/méthodes , Humains , Hypothermie provoquée , Mâle , Adulte d'âge moyen , Valve atrioventriculaire gauche/physiopathologie , Valve atrioventriculaire gauche/chirurgie , Insuffisance mitrale/diagnostic , Insuffisance mitrale/chirurgie , Surveillance peropératoire , Soins périopératoires , Substituts du plasma/usage thérapeutique , Propanolamines/usage thérapeutique , Réintervention/statistiques et données numériques , Reproductibilité des résultats , Sternotomie , Interventions chirurgicales mini-invasives , Systole/physiologie
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