In considering the choice of drugs for general anesthesia in these patients, medications that cause bradycardia should be avoided. Pharmacologic interventions that produce venous dilation may significantly impair cardiac output by reducing preload.9 Increases in ventricular afterload should be avoided. In some patients with AR, inodilator agents such as phosphodiesterase inhibitors or other intropic agents such as β-agonists may be needed to improve left ventricular function.