Anesthetic Management of a Patient With Dynamic Left Ventricular Outflow Tract Obstruction With Systolic Anterior Movement of the Mitral Valve Undergoing Redo–Orthotopic Liver Transplantation

Abstract

present for liver transplantation, they often have a hyperdynamic circulation with a profound increase in their cardiac output (CO) and reduced systemic vascular resistance (SVR). This combination of hemodynamic derangements makes these patients especially prone to dynamic left ventricular outflow tract obstruction (DLVOTO). Aniskevich et al 3 recently published a case report in which DVLOTO with systolic anterior motion (SAM) of the mitral valve was detected for the first time during the reperfusion phase of orthotopic liver transplantation (OLT) in a patient with an unremarkable preoperative cardiac evaluation and uneventful preanhepatic and anhepatic stages. 3 A case of preoperative DLVOTO and SAM of the mitral valve with atrial fibrillation and significant hemodynamic instability presenting in a patient scheduled for redo-OLT is presented. The case was managed successfully with preoperative cardioversion to sinus rhythm and intraoperative hemodynamic management guided by transesophageal echocardiography (TEE).