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[Sigmoid shaped ventricular septum causing hemodynamic deterioration during lumbar anesthesia: a case report]
Takahiro Yokoya1, Jun Moromikawa, Kazuhiro Uehara
1Division of Cardiology, Okinawa Kyodo Hospital, Madanbashi 593-1, Tomigusukuson, Shimajiri-gun, Okinawa 901-0293.
Journal of Cardiology
|November 8, 2002
Summary
A sigmoid shaped ventricular septum, often a normal aging finding, can cause severe left ventricular outflow tract obstruction during anesthesia. Prompt fluid resuscitation resolved the obstruction and stabilized the patient.
Area of Science:
- Cardiology
- Anesthesiology
- Geriatrics
Background:
- Left ventricular outflow tract (LVOT) obstruction can be a rare complication during anesthesia.
- Sigmoid shaped ventricular septum is a common age-related cardiac finding, typically without clinical significance.
Observation:
- A 73-year-old woman developed ST depression and shock 25 minutes after spinal anesthesia induction for hip surgery.
- A grade IV systolic murmur was detected, and echocardiography revealed significant left ventricular outflow tract narrowing with a 170 mmHg gradient.
Findings:
- The patient's condition stabilized rapidly with fluid resuscitation, and she recovered without adverse events.
- Cardiac imaging suggested a sigmoid shaped ventricular septum, not obstructive hypertrophic cardiomyopathy, with no resting gradient.
Implications:
- This case highlights the potential for sigmoid shaped ventricular septum to cause dynamic LVOT obstruction under anesthetic stress.
- Early recognition and prompt fluid management are crucial for managing such anesthetic-induced complications.
- Further research may clarify the predictive factors for outflow obstruction in patients with sigmoid shaped ventricular septum.