[Intraoperative transesophageal echocardiography and systolic anterior motion of the mitral valve: findings during noncardiac surgery].
Systolic anterior motion is an under-recognized cause of acute systemic hypotension during noncardiac surgery. This dynamic event has come to light with the introduction of intraoperative transesophageal echocardiography, which provides anatomic and functional images in real time. The cause of this abnormal motion is still uncertain, although it is thought that changes in the shape and function of the left ventricle allow displacement of the mitral valve annulus so that 1 or more leaflets can be pulled toward the outflow tract and obstruct it during the systole. It is important to recognize and diagnose this phenomenon as a cause of hypotension during noncardiac surgery because it can be treated with volume replacement and beta-blockers. The results of such measures can be monitored on intraoperative echocardiographic images. Volume replacement should increase the size of the ventricle and the beta-blockers should decrease the hyperdynamic state. We report a case of abnormal systolic motion during noncardiac surgery that was managed with the help of echocardiography.
Cabrera Schulmeyer
M C
MC
Departamento de Anestesiología, Hospital Clínico Fuerza Aérea de Chile y Universidad de Valparaíso, Santiago de Chile. carol218@vtr.net
Labbé
M
M
Schmied
S
S
De la Maza
J
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D003131:Combined Modality Therapy; D003199:Computer Systems; D017548:Echocardiography, Transesophageal; D005440:Fluid Therapy; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D016343:Monitoring, Intraoperative / Q000379:methods*; D009038:Motion; D013599:Systole
D000319:Adrenergic beta-Antagonists