Mitral valve replacement: a case report

Mitral regurgitation is commonly encountered in anesthesia clinical practice. Knowledge of the pathophysiology and proper anesthetic management is crucial to achieving optimal outcomes. Surgical advancements and early intervention have led to improved outcomes. An ASA class III, 58-year-old woman with mitral regurgitation secondary to rheumatic fever, presented for repair or replacement of the mitral valve. A graded induction with low-dose narcotic, isoflurane, and phenylephrine was required to maintain acceptable cardiovascular parameters during induction and throughout the case. Additional interventions included adequate preload, normal heart rate, and decreased afterload, to maintain a mean arterial pressure of 65 mm Hg. Ampicillin and gentamicin were administered according to American Heart Association guidelines for prophylactic management against subacute bacterial endocarditis. Milrinone and epinephrine were required for inotropic support until the left ventricle recovered from ischemic time. Milrinone was an ideal inotrope in this case, as its vasodilator properties allowed an increase in forward flow with minimal impact on pulmonary hypertension. Goals for the anesthetist include preservation of forward flow with minimal regurgitation and decreased pulmonary congestion. Invasive monitoring and transesophageal echocardiography have improved diagnostics and anesthetic management.