Preintervention imaging and intraoperative management care of the hypertrophic obstructive cardiomyopathy patient

Abstract

With an estimated overall mortality of less than 1 percent per year, hypertrophic cardiomyopathy, is the most common genetic cardiomyopathy. Intraoperative transesophageal echocardiography is the standard of care for assessing patients with hypertrophic obstructive cardiomyopathy undergoing surgical septal myectomy, allowing surgical planning, intraoperative hemodynamic monitoring, and postprocedural assessment of the repair, including detection of immediate complications. At various phases during surgical septal myectomy, the changing hemodynamic conditions may lead to worsening or improvement in left ventricle outflow tract obstruction by change in preload or afterload, systolic anterior motion of the mitral valve, or sympathetic stimulation. These characteristics represent unique challenges in the management of these patients, requiring a comprehensive understanding of the management of all the conditions required to decrease the left ventricle outflow tract gradient avoiding obstruction, which include the maintenance of sinus rhythm, adequate rate avoiding tachycardia and bradycardia, and avoidance of systemic hypotension preserving preload and afterload, with adequate vasoactive agents. The aim of this review is to summarize the perioperative assessment and management of patients undergoing hypertrophic obstructive myopathy surgery.

Exploring Brain and Heart Interactions during Electroconvulsive Therapy with Point-of-Care Ultrasound

“…The use of POCUS could aid in tailoring anesthesia management to mitigate the risks of hemodynamic fluctuations observed during ECT and to prevent short- and long-term complications such as cardiac ischemia, flash pulmonary edema, and cardiovascular collapse [ 22 , 23 ]. Furthermore, deleterious dynamic conditions, such as obstructive shock secondary to systolic anterior motion (SAM) of the mitral valve, that may be more prevalent in tachycardic and hypovolemic conditions, such as during ECT when patients have been fasting for the procedure, could be more closely monitored and optimized [ 24 , 25 ]. POCUS might also help identify patients who have developed stress cardiomyopathy as a result of ECT or as a result of their underlying psychiatric conditions [ 26 ].…”

The mitral valve in hypertrophic cardiomyopathy

“…TEE can provide excellent image clarity for assessment of the mitral valve and sub-mitral apparatus, and/or mechanism of mitral insufficiency [16 ▪ ]. Intraoperative TEE is used to assess the extent and location of septal thickening, required extent of muscular resection and for presence of residual postoperative SAM [32]. The mid-oesophageal and transgastric long-axis views are particularly useful for defining morphology of the sub-mitral apparatus [16 ▪ ].…”