PMC8851360_01
Three-chambers view: (A) Pre-beta-blocker administration without color doppler. (B)
Pre-beta-blocker administration with color doppler. (C) Post-beta-blocker administration
without color doppler. (D) Post-beta-blocker administration with color doppler. Arrow:
systolic anterior motion of mitral leaflet. In pre-beta-blocker echocardiography, severe
eccentric mitral regurgitation can be seen due to systolic anterior motion of the mitral
valve.
10.1177_23247096211056491-fig1.jpg
PMC8851360_01_10.1177_23247096211056491-fig1.jpg
fig1-23247096211056491
Severe eccentric MR directed posteriorly and laterally, caused by SAM of anterior and posterior leaflets of the mitral valve, was also observed (Figure 1A and B; Figure 2A and B). The TOE recorded 2 minutes after the esmolol administration showed a critical reduction in intraventricular gradient and in SAM of the mitral valve (Figure 1C and D; Figure 2C and D), which in turn resulted in MR improvement.
Four-chambers view: (A) Pre-beta-blocker administration without color doppler. (B)
Pre-beta-blocker administration with color doppler. (C) Post-beta-blocker administration
without color doppler. (D) Post-beta-blocker administration with color doppler. Arrow:
systolic anterior motion of mitral leaflet. In pre-beta-blocker echocardiography, severe
eccentric mitral regurgitation can be seen due to systolic anterior motion of the mitral
valve.
10.1177_23247096211056491-fig2.jpg
PMC8851360_01_10.1177_23247096211056491-fig2.jpg
fig2-23247096211056491
Severe eccentric MR directed posteriorly and laterally, caused by SAM of anterior and posterior leaflets of the mitral valve, was also observed (Figure 1A and B; Figure 2A and B). The TOE recorded 2 minutes after the esmolol administration showed a critical reduction in intraventricular gradient and in SAM of the mitral valve (Figure 1C and D; Figure 2C and D), which in turn resulted in MR improvement.
Chronology and results.. Abbreviations: AIS, acute ischemic stroke; FIO2, fraction of inspired
oxygen; LVOTO, left ventricle outflow tract obstruction; MAP, mean arterial pressure;
Max grad, maximum gradient; MR, mitral regurgitation; NE, norepinephrine; PEEP, positive
end-expiratory pressure; SAM, systolic anterior movement (of anterior mitral
leaflet).
10.1177_23247096211056491-fig3.jpg
PMC8851360_01_10.1177_23247096211056491-fig3.jpg
fig3-23247096211056491
The chronology and hemodynamic results of the intervention are summarized in Figure 3.