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[Perioperative management of patients with dilated cardiomyopathy]
Insights
Dilated cardiomyopathy (DCM) management requires careful preoperative assessment. Echocardiography is crucial for evaluating cardiac function to minimize risks during surgery for DCM patients.
Area of Science:
- Cardiology
- Anesthesiology
- Internal Medicine
Background:
- Dilated cardiomyopathy (DCM) is characterized by ventricular dilation and impaired systolic function.
- Limited literature exists on the perioperative management strategies for patients with DCM.
Observation:
- Two cases of DCM patients undergoing or having surgery withdrawn are presented.
- A 72-year-old male with well-compensated DCM underwent gastrectomy under general anesthesia without complications.
- A 66-year-old male with poorly compensated DCM had surgery withdrawn due to anticipated perioperative cardiac risks.
Findings:
- Preoperative echocardiography is vital for assessing cardiac compensation in DCM patients.
- Careful perioperative management, including anesthesia choice and vasoactive agents, can be successful in compensated DCM.
- Inadequate cardiac reserve in DCM necessitates surgical withdrawal to prevent adverse events.
Implications:
- Preoperative cardiac evaluation is essential for optimizing surgical outcomes in DCM patients.
- Tailored anesthetic and perioperative strategies are critical for managing DCM during surgery.
- This case series highlights the importance of individualized risk assessment in DCM patients facing surgical procedures.
Abstract:
Dilated cardiomyopathy (DCM) is defined as a syndrome of dilated ventricles with gross impairment of ventricular systolic function. However, few reports on perioperative management of DCM were obtainable. This paper describes perioperative management of two patients with DCM. A 72-year-old man, whose DCM had been treated with medication, was planned for gastrectomy. His cardiac signs indicated NYHA class II. Cardiac function, evaluated prior to the surgery with echocardiography to determine an operative indication, turned out to be well compensated. Minimal cardiac derangements were anticipated perioperatively. The procedure was carried out under general anesthesia with neuroleptanalgesia utilizing butorphanol and vasoactive agents. No circulatory complications were observed throughout the surgery. A 66-year-old man, who had long-standing heart disease, hemiplegia and hydronephrosis due to ureteral stone, was planned for percutaneous nephrolithotomy. However, the planned surgery was withdrawn because he had DCM with minimal compensatory function and perioperative cardiac derangements were anticipated according to the categorized data classified with echocardiography. We conclude that preoperative assessment of cardiac function is essential to minimize perioperative cardiac derangements in patients with DCM.