Sudden perioperative death post aortic valve replacement with autopsy showing hypertrophic cardiomyopathy in elderly...

Area of Science:

• Cardiology
• Cardiac Surgery
• Pathology

Background:

• Perioperative death is a significant concern for patients and surgical teams.
• Autopsies are crucial for understanding unexpected perioperative fatalities.
• This case involves a sudden death following aortic valve replacement in an elderly female with undiagnosed hypertrophic cardiomyopathy (HCM).

Purpose of the Study:

• To report a rare case of sudden perioperative death due to undiagnosed hypertrophic cardiomyopathy (HCM) after aortic valve replacement (AVR).
• To highlight the importance of autopsy in explaining unexpected post-operative deaths.
• To underscore the need for genetic screening in families affected by HCM.

Main Methods:

• A 73-year-old female underwent elective aortic valve replacement (AVR) for severe aortic valve stenosis (AS).
• Despite successful surgery, the patient experienced persistent poor left ventricular function and died intraoperatively.
• Post-mortem examination, including heart weight, left ventricular septal hypertrophy measurement, and left ventricular histology, was performed.

Main Results:

• The patient died on the operating table due to unrecoverable poor left ventricular function post-AVR.
• Histological examination revealed significant septal hypertrophy (20 mm) and myocyte disarray, confirming hypertrophic cardiomyopathy (HCM).
• Aortic valve stenosis (AS) is a common indication for AVR, but sudden death can occur post-procedure.

Conclusions:

• Undiagnosed hypertrophic cardiomyopathy (HCM) can lead to sudden unexpected death even after successful aortic valve replacement (AVR).
• Autopsy plays a vital role in diagnosing conditions like HCM and providing closure for families.
• Screening of family members is essential for inherited conditions like HCM to prevent further sudden cardiac deaths.