Unexpected refractory intra-operative hypotension during non-cardiac surgery: Diagnosis and management guided by trans-oesophageal echocardiography.
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.
Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City 52242, Iowa, USA.
Sundara
S
Reddy
Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City 52242, Iowa, USA.
Kenichi
K
Ueda
Anaesthesia; hypotension; intraoperative monitoring; trans-oesophageal echocardiography