title: [Anesthetic management of two patients with hypertrophic obstructive cardiomyopathy for percutaneous transluminal septal myocardial ablation].
abstract: We experienced anesthetic management of two patients with hypertrophic obstructive cardiomyopathy (HOCM) for percutaneous transluminal septal myocardial ablation (PTSMA). PTSMA had been performed more than a year earlier in both cases, and symptoms and exercise tolerance were improved after PTSMA. Laparotomy for suspected ovarian cancer in one patient and thoracotomy for metastatic lung cancer in the other patient were proposed. Preoperative echocardiography showed reduced left ventricular outflow tract pressure gradient (from 90 mmHg before PTSMA to 10 mmHg and from 81 mmHg to 17 mmHg, respectively) and decreased septal wall thickness. Systolic anterior movement of mitral valve apparatus had disappeared. General anesthesia in the former and general anesthesia combined with epidural anesthesia in the latter were employed. Anesthesia was induced with propofol and fentanyl. A laryngeal mask was used to minimize hemodynamic fluctuations during induction and emergence in the former. Anesthesia was maintained with propofol, sevoflurane and supplemental fentanyl. Epidural anesthesia was also used to maintain anesthesia in the latter. The postoperative course was uneventful in each case. PTSMA for HOCM might be useful to prevent perioperative cardiac events.
authors.affiliation: Department of Anesthesiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kishi
authors.forename: Atsuko
authors.initials: A
authors.lastname: Mizobuchi
authors.forename: Michioki
authors.initials: M
authors.lastname: Kuri
authors.forename: Mika
authors.initials: M
authors.lastname: Baba
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Tadanori
authors.initials: T
authors.lastname: Mammoto
authors.forename: Noriko
authors.initials: N
authors.lastname: Kanbara
authors.forename: Toshiko
authors.initials: T
authors.lastname: Sakai
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005283:Fentanyl; D006801:Humans; D007813:Laparotomy; D017214:Laryngeal Masks; D008738:Methyl Ethers; D015742:Propofol; D000077149:Sevoflurane; D013908:Thoracotomy
chemical_list: D008738:Methyl Ethers; D000077149:Sevoflurane; D005283:Fentanyl; D015742:Propofol