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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
PubMed

Insights

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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