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[Hypertrophic cardiomyopathy].
Naritoshi Maki1, Tomoaki Shimizu, Chie Nishiyama
1Department of Anesthesiology, Osaka Police Hospital, Osaka 543-0035.
Masui. the Japanese Journal of Anesthesiology
|August 19, 2010
Summary
This case study highlights managing a patient with hypertrophic cardiomyopathy and low ejection fraction undergoing sigmoid cancer surgery. Careful anesthetic and inotropic support were crucial for successful surgical outcomes.
Area of Science:
- Cardiology
- Anesthesiology
- Surgical Oncology
Background:
- A 68-year-old female patient presented with severe cardiac dysfunction (ejection fraction 16%) secondary to dilated hypertrophic cardiomyopathy.
- The patient was scheduled for high anterior resection due to sigmoid cancer, posing significant anesthetic challenges.
Observation:
- Intraoperative transesophageal echocardiography revealed a further drop in ejection fraction to 9% after anesthesia induction.
- Hemodynamic management involved epidural analgesia, dobutamine infusion, and judicious use of phenylephrine and landiolol.
Findings:
- The surgical procedure and anesthesia were completed without immediate major complications.
- Postoperative day 2 showed worsening congestive heart failure, necessitating increased dobutamine and milrinone administration.
Implications:
- This case underscores the complex perioperative management required for patients with severe left ventricular dysfunction undergoing major surgery.
- Optimizing inotropic support and hemodynamic stability is critical for improving outcomes in high-risk surgical patients with cardiomyopathy.
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