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Nursing management in Systolic Anterior Motion of Mitral Valve after the Mitral Valve Repair: A Clinical Case

May 26, 2023 from 2:55pm EDT to 3:25pm EDT

All patients undergoing Mitral Valve (MV) repair are at risk for Systolic Anterior Motion (SAM). SAM is defined as the prolapse of the anterior leaflet into the left ventricular outflow tract (LVOT) during systole, causing LVOT obstruction with concomitant mitral regurgitation (MR), in patients after MV repair. As a result, cardiac output drops. SAM associated LVOT obstruction or MR accounts up to 20% risk of sudden cardiac death. To keep the LVOT open, the left ventricle's optimal expansion must be maintained, and its contractility must be reduced. The purpose of this review is to highlight the need for educating CV nurses as lack of knowledge about SAM may lead to life threatening complications.

A 60-year-old man admitted to cardiac surgical ICU after MV repair. History and risk factors included rheumatic heart disease, hypertension, obstructive sleep apnea, and obesity. Two days postop, he abruptly drops his BP, is tachycardic, and exhibits a new systolic murmur. Bedside transesophageal echocardiography (TEE) shows severe MR secondary to SAM. Prompt administration of fluids to optimize LV filling and weaning off inotropes gradually resolved SAM and LVOT obstruction. Understanding of SAM, hypertrophic obstructive cardiomyopathy, and fluid deficit/overload after MV repair is vital for CV nurses.

SAM is a potential negative occurrence after MV repair. It is imperative that cardiovascular nurses focus care on cautious administration of fluids and inotropes to prevent LVOT obstruction. This emphasizes the increased learning requirements for CV nurses in the early identification and management of patients with SAM after MV repair.

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