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Intraoperative evaluation and surgical planning in the hypertrophic cardiomyopathy

Maria Fernanda Maretti A Garcia1, Maria Estefânia B Otto, Núbia Welerson Vieira

  • 1Instituto de Cardiologia do Distrito Federal, Fundação Universitária de Cardiologia, Brasilia, DF, Brazil.

Arquivos Brasileiros De Cardiologia
|April 13, 2011
PubMed

Insights

Diagnosis of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy was confirmed during surgery. Transesophageal echocardiography with isoproterenol proved crucial for identifying the obstruction, leading to successful septal myectomy.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Hypertrophic cardiomyopathy (HCM) can lead to left ventricular outflow tract (LVOT) obstruction.
  • Optimized medical management may not prevent clinical deterioration in some HCM patients.

Observation:

  • A 45-year-old male with HCM and a history of cardioverter-defibrillator implant experienced progressive clinical decline.
  • Resting echocardiography and dobutamine stress testing were inconclusive for diagnosing significant LVOT obstruction.

Findings:

  • Intraoperative transesophageal echocardiography (TEE) utilizing isoproterenol successfully identified significant obstruction in the EPLV.
  • Septum myectomy was performed, effectively relieving the obstruction.

Implications:

  • Intraoperative TEE with pharmacologic stress is a valuable tool for diagnosing elusive LVOT obstruction in HCM.
  • Surgical intervention (septum myectomy) can significantly improve outcomes in carefully selected HCM patients with obstructive physiology.

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