Anaesthesia and perioperative transoesophageal echocardiography in obstructive hypertrophic cardiomyopathy

Area of Science:

• Cardiology
• Cardiovascular Medicine

Background:

• Hypertrophic cardiomyopathy (HCM) is a myocardial disease characterized by thickening, remodeling, and reduced chamber size.
• Disarrayed myocardial fibers cause asymmetric thickening, with diagnosis often based on left ventricle wall thickness >15 mm and specific septal-to-posterior ratios.
• Common features include left ventricle outflow tract obstruction (LVOTO), systolic anterior motion (SAM) of the mitral valve, and mitral regurgitation (MR).

Purpose of the Study:

• To review anesthetic considerations for patients with obstructive hypertrophic cardiomyopathy.
• To highlight intraoperative transesophageal echocardiography (TEE) applications in managing obstructive HCM.
• To discuss postoperative management strategies for patients with obstructive HCM.

Main Methods:

• This is a review article, synthesizing existing knowledge on anesthetic and perioperative management of obstructive HCM.
• Key diagnostic criteria and common clinical features of HCM are discussed.
• Focus is placed on anesthetic implications, TEE use, and postoperative care.

Main Results:

• Obstructive HCM presents with potential for dynamic LVOTO, SAM, and MR, leading to symptoms like dyspnea, syncope, heart failure, or sudden cardiac death (SCD).
• Anesthetic management requires careful consideration of hemodynamics to avoid exacerbating LVOTO.
• Intraoperative TEE is crucial for assessing cardiac function and guiding management.

Conclusions:

• Effective perioperative management is vital for patients with obstructive HCM to mitigate risks associated with anesthesia and surgery.
• Understanding HCM pathophysiology and potential complications is essential for anesthesiologists and cardiac care teams.
• This review provides a framework for optimizing care in this patient population.