Key result
Point-of-care echocardiography provided a rapid and thorough evaluation of an unexpected systolic murmur, ruling out severe pathology and avoiding surgical delay.
Why the study?
Systolic murmurs suggesting aortic valve stenosis or LVOT obstruction usually require preoperative echocardiographic evaluation before elective surgery.
Case Report (n=1)
No
Point-of-care echocardiography performed by anesthesiologists can rapidly and effectively evaluate unexpected systolic murmurs preoperatively, preventing unnecessary surgical delays.
POC TTE enabled rapid preoperative murmur evaluation; leaves open need for prospective validation before routine use.
BACKGROUND: Systolic murmur suggesting the association of aortic valve (AV) stenosis or obstructive pathology in the left ventricular outflow tract (LVOT) usually requires preoperative echocardiographic evaluation for elective surgery. CASE: In a 63-year-old female patient undergoing elective thoracic surgery, the systolic murmur was auscultated on the right sternal border of the second intercostal space in the preoperative patient holding area. Point-of-care (POC) transthoracic echocardiography (TTE) demonstrated a systolic jet flow in the LVOT area. The peak systolic velocity of the continuous wave Doppler tracing, aligned to the LVOT and the AV, was approximately 1.5 m/s. The peak/mean pressure gradient was 11/6 mmHg for the AV and 9/5 mmHg for the LVOT. Anesthesia was induced under continuous TTE imaging. Intraoperative transesophageal echocardiography also confirmed the absence of any cardiac pathology. CONCLUSIONS: POC echocardiography offered a thorough preoperative evaluation of an unexpectedly identified systolic murmur, avoiding a potential delay in the operation schedule for conventional preoperative echocardiographic evaluation.
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Lee et al. (2024) conducted a case report in Systolic murmur (n=1). Point-of-care (POC) echocardiography was evaluated on Identification of cardiac pathology (AV stenosis or LVOT obstruction). Point-of-care echocardiography provided a rapid and thorough evaluation of an unexpected systolic murmur, ruling out severe pathology and avoiding surgical delay.
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