[Anesthetic management of a patient with severe aortic stenosis undergoing spine surgery]

An 87-year-old man with severe aortic stenosis (AS), refusing aortic valve surgery, was scheduled to undergo posterior spinal fusion. According to American College of Cardiology/American Heart Association (ACC/AHA) 2008 Guideline, aortic valve surgery is recommended before non-cardiac surgery in a patient with severe AS. Several reports have noted that non-cardiac surgery could be performed safely with careful anesthetic management by adjusting left ventricular preload and systemic arterial pressure, and avoiding tachycardia. We used pulmonary artery catheter to estimate left ventricular preload, which is an especially essential factor for maintaining cardiac output. Transesophageal echocardiography has been proved to be superior to pulmonary artery catheter for evaluating left ventricular preload. However, it is difficult to perform in the prone position. Although pulmonary artery wedge pressure (PAWP) is influenced in prone position due to the chest compression, PAWP combined with cardiac index and their responsiveness to fluid administration is valuable in hemodynamic management in a patient with severe AS.