The general hemodynamic goal in treating mitral insufficiency is to preserve forward flow (and reduce regurgitant flow). Regurgitant flow decreases with decreasing size of regurgitant orifice, small pressure difference between LA and LV and duration of systole. This can be accomplished by maintenance of sinus rhythm, preload, inotropic state, afterload reduction, avoidance of bradycardia.
Pharmacologic strategies to achieve these goals:
- Low-dose epinephrine
- Ephedrine (instead of phenylephrine)
- Intra-aortic balloon pump