Sudden hypoxemia after uneventful laparoscopic cholecystectomy: another form of SAM presentation

Abstract

BackgroundPerioperative dynamic left ventricular outflow obstruction associated with systolic anterior motion of the mitral valve is well recognized as a cause for unexplained sudden hypotension in perioperative settings, even without underlying heart diseases such as hypertrophic obstructive cardiomyopathy. We treated a patient who experienced sudden hypoxemia without severe hypotension during emergence from anesthesia after an uneventful laparoscopic cholecystectomy.Case presentationA 65-year-old female patient with a history of hypertension presented a sudden decrease in oxygen saturation to 80% after an uneventful cholecystectomy. Although a portable chest radiograph showed bilateral hilar pulmonary infiltrates consistent with pulmonary edema, we explored the underlying cause, i.e., systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction with bedside transthoracic echocardiography. We speculate that dynamic mitral regurgitation resulted in pulmonary edema and, thereby, hypoxemia in this case without severe hypotension.ConclusionsCareful bedside examination with transthoracic echocardiography was useful in making diagnosis and in guiding appropriate therapy for this patient. Clinicians should be aware that systolic anterior motion of the mitral valve may present as unexplained sudden hypoxemia in the perioperative setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0031-y) contains supplementary material, which is available to authorized users.

Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients With Drug-Refractory Hypertrophic Obstructive Cardiomyopathy

“…Systolic anterior motion is a well-recognized cause for unexplained or sudden hypotension in the cardiac perioperative setting. [30][31][32] The 2020 American Heart Association/American College of Cardiology Guideline for HCM emphasized maximizing preload and afterload to avoid hypotension, 1 which may also apply to patients following the PIMSRA procedure. Although 29% of patients were in NYHA class II before PIMSRA, they had limiting angina without epicardial coronary artery disease on coronary computed tomography angiography and likely related to drug-refractory severe LVOT obstruction.…”

Unexpected systolic anterior motion of the mitral valve-related hypoxemia during transurethral resection of the prostate under spinal anesthesia: a case report

“…It consists of the anterior movement of the mitral valve leaflets towards the LVOT during systole, causing LVOT obstruction and resultant MR, leading to reduction in cardiac output and hemodynamic collapse [ 1 ]. Typically, it is common in patients with HCM or may be a complication of certain cardiac surgeries, such as mitral valve repair and aortic valve replacement [ 2 , 4 , 5 ]. Conditions that cause cardiac septal wall motion abnormalities or changes in LV geometry, including diabetes mellitus, hypertensive heart disease, and acute myocardial infarction can sometimes result in this phenomenon as well [ 6 ].…”

“…Systolic anterior motion (SAM) of the mitral valve is defined as the anterior displacement of a mitral leaflet toward the left ventricular outflow tract (LVOT) during systole, causing LVOT obstruction and mitral regurgitation (MR) [ 1 ]. The typical manifestation is unexpected cardiovascular collapse, commonly seen in patients with hypertrophic cardiomyopathy (HCM) [ 2 ]. Notably, in the absence of underlying cardiac disease, SAM may also be triggered by increased catecholaminergic stimulation and reduction in ventricular preload, such as hypovolemia, anesthesia-mediated vasodilatation or neuraxial anesthesia [ 3 , 4 ].…”

Type II myocardial infarction and latent LVOT obstruction due to Systolic Anterior Motion of mitral valve

“…Systolic anterior motion (SAM) is de ined as displacement of the distal portion of the anterior lea let of the mitral valve toward the left ventricular out low area (LVOA) [2]. SAM can occur not only in patients with hypertrophic cardiomyopathy which is one of the hallmark echocardiographic indings, but also in patents without the disease [3] and is a well-recognized cause for unexplained sudden hypotension [4]. Predisposing factors that cause SAM are:…”