Anesth Analg 2002;94:310-312
© 2002 International Anesthesia Research Society
CARDIOVASCULAR ANESTHESIA
An Intraoperative Diagnosis of Dynamic Left Ventricular Outflow Tract Obstruction Using Transesophageal Echocardiography Leads to the Treatment with Intravenous Disopyramide
Minako Ashidagawa, MD,
Maria Ohara, MD, and
Yasuhiro Koide, MD
Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama, Japan
Address correspondence and reprint requests to Yasuhiro Koide, MD, Department of Anesthesiology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004 Japan. Address e-mail to hiro{at}med.yokohama-cu.ac.jp
Hypertrophic obstructive cardiomyopathy (HOCM) is an uncommon familial disorder, traditionally characterized by asymmetric septal hypertrophy and left ventricular outflow tract (LVOT) obstruction (1). It is now recognized that HOCM may also include those patients with secondary left ventricular hypertrophy (LVH) and dynamic LVOT obstruction. In particular, a syndrome with similar clinical and echocardiographic findings has been identified in elderly patients exhibiting concentric LVH with chronic hypertension, aortic stenosis, or sigmoid-shaped septum (2).
IMPLICATIONS: During surgery, dynamic left ventricular outflow obstruction (LVOT) can potentially occur frequently, but diagnosis may be less frequent. When circulatory disturbance occurs with suspicion of LVOT obstruction, transesophageal echocardiography can provide exact proof of diagnosis and basis for immediate treatment.
|