Anesthetic management of a patient with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation: Early postinterventional period and anesthetic considerations

Abstract

IN PATIENTS with hypertrophic cardiomyopathy, positive inotropic drugs, decreasing venous return, or systemic vascular resistance worsens the obstruction of the left ventricular outflow tract, 1 Thompson RC Liberthson RR Lowenstein E Perioperative anesthetic risk of noncardiac surgery in hypertrophic obstructive cardiomyopathy. JAMA. 1985; 254: 2419-2421 Crossref PubMed Scopus (77) Google Scholar , 2 Wigle ED Rakowski H Kimball BP et al. Hypertrophic cardiomyopathy. Clinical spectrum and treatment. Circulation. 1995; 92: 1680-1692 Crossref PubMed Scopus (698) Google Scholar and serious problems might occur during general anesthesia. Percutaneous transluminal septal myocardial ablation (PTSMA), in which septal branches of the left anterior descending coronary artery are occluded with ethanol, has been performed as catheter treatment for hypertrophic obstructive cardiomyopathy (HOCM). 3 Sigwart U Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995; 346: 211-214 Abstract PubMed Google Scholar , 4 Faber L Seggewiss H Gleichmann U Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: Results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998; 98: 2415-2421 Crossref PubMed Scopus (308) Google Scholar , 5 Knight C Kurbaan AS Seggewiss H et al. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: Outcome in the first series of patients. Circulation. 1997; 95: 2075-2081 Crossref PubMed Scopus (281) Google Scholar There is no report, however, on the effects of general anesthesia in patients with this procedure. A case of general anesthesia in a patient with HOCM, who underwent PTSMA 1 week before surgery, is reported.