Abstract
A 68-year-old patient with triple vessel coronary artery disease was scheduled for elective coronary artery bypass grafting. Three days after the uneventful surgery, the patient went into cardiogenic shock, which was deemed to be caused by a dynamic left ventricular outflow tract obstruction and high-grade mitral regurgitation, which both had not been present before surgery. On an emergency basis, surgical transvalvular septal myectomy and mitral valve replacement were performed. After initial extra corporeal membrane oxygenation (ECMO) therapy and a prolonged (intensive care unit) ICU stay the patient finally recovered and is well one and a half years after surgery.
Highlights
One day later, during the morning round, blood pressure was normal, CK-MB had further dropped to 23 U/L, body weight was 98 kg, the urinary catheter was removed
Dynamic hypertrophic left ventricular outflow tract obstruction in a patient with a previously normal interventricular septum has been described after myocardial infarction
To our no such case ofand dynamic or reactive left ventricular hypertroof a patient withknowledge coronary artery disease a history of hypertrophic obstructive carphy and subsequent cardiogenic shock has been described for any patient after CABG
Summary
Intraoperative transesophageal echocardiography showed normal left ventricular function and an inconspicuous interventricular septum. Treatment with the calcium sensitizer levosimendan was begun, under which regimen cardiac function improved, the patient awoke and was responsive so that veno-arterial ECMO was discontinued three days thereafter. A transesophageal echocardiography revealed a severely thickened interventricular septum (Figure 1) with a gradient over 100 mmHg and a SAM
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