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. 2014 Jan;58(1):51-4.
doi: 10.4103/0019-5049.126796.

Unexpected refractory intra-operative hypotension during non-cardiac surgery: Diagnosis and management guided by trans-oesophageal echocardiography

Sundara Reddy  1 , Kenichi Ueda  1
Affiliations

Unexpected refractory intra-operative hypotension during non-cardiac surgery: Diagnosis and management guided by trans-oesophageal echocardiography

Sundara Reddy et al. Indian J Anaesth. 2014 Jan.

Abstract

We present a case of severe refractory hypotension in a patient undergoing de-bulking liver resection for massive polycystic liver disease. Emergent trans-oesophageal echocardiography (TOE) revealed dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Notably, he had a structurally normal heart on pre-operative trans-thoracic echocardiography (TTE). Diagnosis of SAM by TOE, possible mechanisms and specific management of refractory hypotension in this context are discussed.

Keywords: Anaesthesia; hypotension; intraoperative monitoring; trans-oesophageal echocardiography.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Hemodynamic trends
Figure 2
Figure 2
TOE: Mid-oesophageal short axis view demonstrating SAM. LA – Left atrium, LV – Left ventricle, AML – Anterior mitral leaflet, LVOT – Left ventricular outflow tract, RV – Right ventricle
Figure 3
Figure 3
Illustration of systolic anterior motion (SAM) of mitral valve. RV – Right ventricle, LV – Left ventricle, LA – Left atrium, MR – Mitral regurgitation, LVOT – Left ventricular outflow tract, AML – Anterior mitral leaflet, PML – Posterior mitral leaflet
See this image and copyright information in PMC

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