Key result
TEE identifies previously undiagnosed HOCM as the cause of sudden intraoperative hypotension.
Why the study?
Dynamic left ventricular outflow obstruction during surgery can cause unexplained intraoperative hypotension that may be misdiagnosed and mistreated without appropriate imaging.
Case Report (n=1)
Transesophageal echocardiography is a valuable tool for rapidly diagnosing unexpected causes of intraoperative hypotension, such as dynamic left ventricular outflow obstruction from undiagnosed HOCM.
Single case supports TEE for unexplained hypotension; leaves open whether routine use improves outcomes in noncardiac surgery.
We present a case of previously undiagnosed hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow obstruction in a woman anesthetized for lumbar hemilaminectomy and diskectomy. The treatment of her sudden unexplained hypotension was initially confounded by a diagnosis of compensated congestive heart failure and diuretic therapy. Swift intervention with transesophageal echocardiography revealed the tru pathology altering her intraoperative treatment and her subsequent chronic treatment for her heart condition.
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Zvara et al. (2002) conducted a case report in Hypertrophic obstructive cardiomyopathy with intraoperative hypotension (n=1). Transesophageal echocardiography was evaluated on Identification of true pathology altering intraoperative and chronic treatment. Transesophageal echocardiography successfully identified previously undiagnosed hypertrophic obstructive cardiomyopathy as the cause of sudden intraoperative hypotension during lumbar laminectomy.
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