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[Severe mitral regurgitation associated with systolic anterior motion of mitral valve occurring after aortic valve replacement and myectomy for aortic stenosis and hypertrophic obstructive cardiomyopathy].

Masui. The Japanese journal of anesthesiology 59(5):635 (2010) PMID 20486580

We treated a patient with severe mitral regurgitation associated with systolic anterior motion of the mitral valve that occurred after aortic valve replacement and a myectomy for aortic stenosis and hypertrophic obstructive cardiomyopathy. A 76-year-old woman with aortic stenosis and hypertrophic obstructive cardiomyopathy underwent aortic valve replacement and a myectomy. Following these procedures, transesophageal echocardiography showed severe mitral regurgitation associated with systolic anterior motion. Neither adequate volume loading nor beta-blocker administration was effective for improvement of the systolic anterior motion, but vasoconstrictor administration was effective. We also performed mitral valve replacement. To the best of our knowledge, this is the first reported case of intraoperative management following aortic valve replacement and myectomy for aortic stenosis complicated with hypertrophic obstructive cardiomyopathy. Transesophageal echocardiography was very useful for intraoperative assessment and developing a strategy for improving severe mitral regurgitation.

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