Sudden hypoxemia after uneventful laparoscopic cholecystectomy: another form of SAM presentation.
BACKGROUND
Perioperative dynamic left ventricular outflow obstruction associated with systolic anterior motion of the mitral valve is well recognized as a cause for unexplained sudden hypotension in perioperative settings, even without underlying heart diseases such as hypertrophic obstructive cardiomyopathy. We treated a patient who experienced sudden hypoxemia without severe hypotension during emergence from anesthesia after an uneventful laparoscopic cholecystectomy.


METHODS
A 65-year-old female patient with a history of hypertension presented a sudden decrease in oxygen saturation to 80% after an uneventful cholecystectomy. Although a portable chest radiograph showed bilateral hilar pulmonary infiltrates consistent with pulmonary edema, we explored the underlying cause, i.e., systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction with bedside transthoracic echocardiography. We speculate that dynamic mitral regurgitation resulted in pulmonary edema and, thereby, hypoxemia in this case without severe hypotension.


CONCLUSIONS
Careful bedside examination with transthoracic echocardiography was useful in making diagnosis and in guiding appropriate therapy for this patient. Clinicians should be aware that systolic anterior motion of the mitral valve may present as unexplained sudden hypoxemia in the perioperative setting.
Department of Anesthesiology & ICM, Kawasaki Medical School, Okayama, Japan. fujitay@med.kawasaki-ma.ac.jp.
Yoshihisa
Y
Fujita
Division of Cardiology, Internal Medicine, Kawasaki Medical School, Department of Cardiology, Present affiliation: The Sakakibara Heart Institute of Okayama, Okayama, Japan. kgnb_27_hot@yahoo.co.jp.
Nobuyuki
N
Kagiyama
Department of Anesthesiology & ICM, Kawasaki Medical School, Okayama, Japan. yoshiday@med.kawasaki-m.ac.jp.
Yuka
Y
Sakuta
Department of Anesthesiology & ICM, Kawasaki Medical School, Okayama, Japan. mywingsnevergiveuptoflytodream@hotmail.co.jp.
Masatsugu
M
Tsuge
D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D004452:Echocardiography; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D018810:Magnetic Resonance Angiography; D008944:Mitral Valve Insufficiency / Q000150:complications*; D064847:Multimodal Imaging; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000209:etiology*; D011654:Pulmonary Edema / Q000209:etiology