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Dynamic left ventricular outflow obstruction during lumbar laminectomy as an unexpected cause of intraoperative

David A Zvara1, Michael A Olympio, Michael J Frankland

  • 1Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.

Journal of Neurosurgical Anesthesiology
|March 22, 2002
PubMed

Insights

A woman with undiagnosed hypertrophic obstructive cardiomyopathy (HOCM) experienced hypotension during surgery. Transesophageal echocardiography identified HOCM, guiding immediate and long-term treatment.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Cardiovascular Surgery

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) can present with left ventricular outflow obstruction.
  • Anesthesia can exacerbate hemodynamic instability in patients with undiagnosed cardiac conditions.

Observation:

  • A patient undergoing lumbar surgery developed unexplained hypotension.
  • Initial management focused on compensated congestive heart failure with diuretics.

Findings:

  • Transesophageal echocardiography revealed previously undiagnosed hypertrophic obstructive cardiomyopathy (HOCM).
  • The echocardiographic findings identified left ventricular outflow obstruction as the cause of hypotension.

Implications:

  • Accurate intraoperative diagnosis of HOCM is crucial for appropriate management.
  • Echocardiography is vital for identifying cardiac pathology influencing surgical treatment.
  • This case highlights the importance of considering cardiac causes of hypotension in surgical patients.

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