Key result
Tailored anesthesia enables successful emergency cesarean section in a patient with severe HOCM.
Case Report (n=1)
No
Successful anaesthetic management of a pregnant patient with HOCM and severe LVOT obstruction undergoing emergency caesarean section requires careful avoidance of factors that exacerbate outflow tract obstruction.
Successful management feasible with tailored care; extends sparse case data but leaves open optimal protocols.
Hypertrophic cardiomyopathy is characterised by asymmetric hypertrophy of the interventricular septum causing intermittent obstruction of the left ventricular outflow tract. This disease may present to the anaesthesiologist in an undiagnosed form during routine pre-operative visit. Surgery and anaesthesia often complicate the peri-operative outcome in this group of patients. A 22-year-old patient was brought in for emergency lower segment caesarean section. She was a diagnosed case of hypertrophic obstructive cardiomyopathy (HOCM) with severe left ventricular outflow tract obstruction and moderate subaortic stenosis. Factors such as tachycardia, hypovolemia, vasodilatation, and increased cardiac contractility leads to exacerbation of this obstruction. We managed this case successfully considering the pathological issues caused by the disease and pregnancy.
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Bhalerao et al. (2017) conducted a case report in Hypertrophic obstructive cardiomyopathy (HOCM) (n=1). Anaesthetic management was evaluated on Peri-operative outcome. Anaesthetic management of a 22-year-old pregnant patient with severe hypertrophic obstructive cardiomyopathy undergoing emergency caesarean section was performed successfully.
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