[Intraoperative arrhythmias in a patient with mitral valve prolapse]

We report a case of mitral valve prolapse in which the first manifestation was the occurrence of arrhythmias during anesthesia. A 28 years old female patient, ASA I, without previous medical or surgical history was programmed for surgical repair of an anal fistula. Preoperative physical and laboratory examination were normal. During anesthetic induction with propofol and droperidol and coinciding with orotracheal intubation the patient developed ventricular premature beats, bigeminy, and runs of ventricular tachycardia which were controlled with intravenous lidocaine. Anesthesia was maintained with 66% of O2/N2O, 0.5 to 1% of isoflurane, alfentanil, and atracurium. At the beginning of the intervention the patient presented an episode of supraventricular tachycardia at a rate of 140 to 160 beats/min which did not respond to a deeper anesthetic level nor to the administration of 5 mg of verapamil. This arrhythmia was finally interrupted with 3 mg of propranolol and it did not relapse during the surgical procedure. We discuss the physiopathology of the lesion, the possible arrhythmic effect of the anesthetic agents used in this case, and the effects of several pathologic situations (anemia, pain, anxiety, hypovolemia, etc) documented in patient with this abnormality.