Key result
TEE identifies mitral valve SAM causing persistent orthostatic hypotension after left intrapericardial pneumonectomy.
Case Report (n=1)
Highlights the utility of transesophageal echocardiography in diagnosing systolic anterior motion of the mitral valve as a cause of unexplained perioperative hypotension in patients without hypertrophic cardiomyopathy.
SAM may explain unexplained orthostatic hypotension after pneumonectomy; this case report leaves open its true incidence and causality.
Systolic anterior motion (SAM) is defined as displacement of the distal portion of the anterior leaflet of the mitral valve toward the left ventricular outflow tract obstruction. SAM can occur in patients without hypertrophic cardiomyopathy (HOCM) and is a well-recognized cause for unexplained sudden hypotension in perioperative settings. We present a case of persistent orthostatic hypotension caused by SAM following left intrapericardial pneumonectomy and mediastinal lymph node dissection for squamous cell carcinoma of the lung invading intrapericardial portion of the inferior pulmonary vein. Diagnosis of SAM was possible with the use of transesophageal echocardiography (TEE).
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Lasala et al. (2017) conducted a case report in Postural hypotension following left intrapericardial pneumonectomy (n=1). Left intrapericardial pneumonectomy and mediastinal lymph node dissection was evaluated on Diagnosis of systolic anterior motion (SAM) causing persistent orthostatic hypotension. Systolic anterior motion of the mitral valve, diagnosed via transesophageal echocardiography, was identified as the cause of persistent orthostatic hypotension following left intrapericardial pneumonectomy.
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