Trans-oesophageal echocardiography is a valuable diagnostic tool for identifying unexpected causes of refractory intra-operative hypotension, such as systolic anterior motion of the mitral valve in structurally normal hearts, thereby guiding appropriate management.
May support TOE for refractory intra-operative hypotension; leaves open routine use pending prospective data.
We present a case of severe refractory hypotension in a patient undergoing de-bulking liver resection for massive polycystic liver disease. Emergent trans-oesophageal echocardiography (TOE) revealed dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Notably, he had a structurally normal heart on pre-operative trans-thoracic echocardiography (TTE). Diagnosis of SAM by TOE, possible mechanisms and specific management of refractory hypotension in this context are discussed.
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Reddy et al. (2014) studied this question.
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