When Intraoperative Hypotension Is Not What It Seems: Systolic Anterior Motion of the Mitral Valve Causing Severe Hypotension During Noncardiac Surgery

Figures

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  FIGURE 1. Midesophageal four chamber view in end systole demonstrating SAM of the anterior mitral valve leaflet (red arrow).

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  FIGURE 2. (a) Midesophageal long‐axis view in systole demonstrating SAM of the anterior mitral valve leaflet (red arrow). (b) Midesophageal long‐axis view in systole with color flow Doppler demonstrating flow acceleration through the left ventricular outflow tract (red arrow) and posteriorly directed mitral regurgitation jet secondary to SAM (blue arrow).

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  FIGURE 3. (a) Deep transgastric view demonstrating SAM (red arrow). (b) Deep transgastric view with color Doppler demonstrating flow acceleration through the left ventricular outflow tract (red arrow).

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  FIGURE 4. Deep transgastric TEE view with continuous‐wave Doppler across the LVOT and aortic valve, demonstrating a late‐systolic‐peaking, dagger‐shaped spectral envelope in a patient with SAM and dynamic LVOT obstruction.

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  FIGURE 5. Apical three‐chamber view with continuous‐wave Doppler across the aortic valve, demonstrating the rounded spectral envelope of fixed valvular aortic stenosis and a mean transaortic gradient of 78 mmHg, consistent with severe aortic stenosis.