Key result
TEE successfully diagnoses SAM causing severe hypotension during OPCAB to guide targeted medical management.
Case Report (n=1)
No
Transesophageal echocardiography is crucial for diagnosing systolic anterior motion of the mitral valve during off-pump coronary artery bypass surgery, as conventional hypotension treatments can worsen the condition.
May support TEE for SAM-related hypotension in OPCAB; hypothesis-generating pending prospective studies.
Systolic anterior motion of the mitral valve (SAM) is well known in the concentric left ventricular hypertrophy or post mitral valvuloplasty.However, SAM has not been reported in Off-pump coronary artery bypass surgery (OPCAB).Preoperatively, SAM in combination with a left ventricular outflow tract obstruction leads to severe cardiovascular destabilization.Moreover, a diagnosis of SAM is very important because the administration of conventional therapy to hypotension can aggravate SAM.We report a patient with un-identified left ventricular wall hypertrophy or mitral valve regurgitation, who was diagnosed with SAM by TEE during OPCAB.This report describes the diagnostic and therapeutic strategies for the perioperative management of SAM.(Korean J Anesthesiol 2007; 53: 242～5)
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Seol et al. (2007) conducted a case report in Perioperative hypotension due to systolic anterior motion of the mitral valve during OPCAB (n=1). Transesophageal echocardiography and preload maintenance was evaluated on Resolution of hypotension and SAM. Transesophageal echocardiography successfully diagnosed systolic anterior motion of the mitral valve as the cause of severe hypotension during off-pump coronary artery bypass surgery, which was managed by maintaining preload and avoiding nitrates and inotropes.
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