title: Exacerbation of left ventricular outlet obstruction in hypertrophic obstructive cardiomyopathy: an unexpected complication of gastric banding.
abstract: Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by a dynamic left ventricular outlet tract (LVOT) obstruction, which may be exacerbated by reduced preload and Valsalva. Laparoscopic adjustable gastric band (LAGB) placement is a restrictive bariatric procedure which may be complicated by recurrent vomiting and Valsalva. Pre-operative cardiac evaluation of patients scheduled for LAGB usually focuses on ischemic heart disease. Reported here is the case of a 64-year-old female admitted for evaluation of recurrent pre-syncopal episodes. The patient was diagnosed with HOCM with a significant increase in an LVOT pressure gradient during Valsalva. Thus, recurrent vomiting secondary to LAGB exacerbated a pre-existing cardiomyopathy. Symptoms resolved after gastric band deflation. This is the first report of such a complication after LAGB, demonstrating the hemodynamics of HOCM in a unique setting and underscoring the need for a structural cardiac assessment prior to bariatric surgery.
authors.affiliation: Department of general Surgery, Hillel Yaffe Medical Center, Hadera, Israel Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel mahamidam@yahoo.com.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Mahamid
authors.affiliation: Department of Internal Medicine Ward A, Hadassah- Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Mizrahi
authors.affiliation: Department of Internal Medicine Ward A, Hadassah- Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Chamutal
authors.initials: C
authors.lastname: Gur
authors.affiliation: Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Tomer
authors.initials: T
authors.lastname: Adar