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Review
. 2022 Jan;30(1):35-42.
doi: 10.1177/02184923211047126. Epub 2021 Sep 24.

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

Jacobo Moreno Garijo  1 , Cristina Ibáñez  2 , Juan M Perdomo  2 , Martin D Abel  3 , Massimiliano Meineri  4
Affiliations
Review

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

Jacobo Moreno Garijo et al. Asian Cardiovasc Thorac Ann. 2022 Jan.

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.

Keywords: Hypertrophic obstructive cardiomyopathy; cardiac; mitral systolic anterior motion; septal myectomy; transesophageal echocardiography.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preprocedural TEE examination in HOCM patients. TEE: transesophageal echocardiography; HOCM: hypertrophic obstructive cardiomyopathy.
See this image and copyright information in PMC

References

    1. Nagueh SF, Bierig SM, Budoff MJ, et al. American society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with hypertrophic cardiomyopathy: endorsed by the American society of nuclear cardiology, society for cardiovascular magnetic resonance, and society of cardiovascular computed tomography. J Am Soc Echocardiogr 2011; 24: 473–498. - PubMed
    1. Nampiaparampil RG, Swistel DG, Schlame Met al. et al. Intraoperative two- and three-dimensional transesophageal echocardiography in combined myectomy-mitral operations for hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2018; 31: 275–288. - PubMed
    1. Nicoara A, Skubas N, Ad N, et al. Guidelines for the use of transesophageal echocardiography to assist with surgical decision-making in the operating room: a surgery-based approach: from the American society of echocardiography in collaboration with the society of cardiovascular anesthesiologists and the society of thoracic surgeons. J Am Soc Echocardiogr 2020; 33: 692–734. - PubMed
    1. Conklin HM, Huang X, Davies CHet al. et al. Biphasic left ventricular outflow and its mechanism in hypertrophic obstructive cardiomyopathy. J Am Soc Echocardiogr 2004; 17: 375–383. - PubMed
    1. Qin JX, Shiota T, Lever HM, et al. Impact of left ventricular outflow tract area on systolic outflow velocity in hypertrophic cardiomyopathy: a real-time three-dimensional echocardiographic study. J Am Coll Cardiol 2002; 39: 308–314. - PubMed

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