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Year : 2007  |  Volume : 51  |  Issue : 2  |  Page : 134

Anaesthesia management of a patient with hypertrophic obstructive cardiomyopathy undergoing Morrow's septal myectomy

1 Senior Resident, Department of Cardio thoracic surgery, AIIMS, India
2 Assoc. Prof., Department of Cardio thoracic surgery, AIIMS, India
3 Additional Prof., Department of Cardio thoracic surgery. AIIMS, India
4 Prof. & Head. Department of Cardiac Anaesthesia, AIIMS, India

Correspondence Address:
Poonam Malhotra Kapoor
CNC, AIIMS, New Delhi
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Source of Support: None, Conflict of Interest: None

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Hypertrophic obstructive cardiomyopathy (HOCM) is a rare disorder. There is paucity of literature on anaesthetic management of this disorder. Aim of this case report is to highlight the anaesthetic problems encountered during management of such patients. A thirty-five year old male was admitted with atypical chest pain for last one year. X-ray chest revealed cardiomegaly (CT ratio 0.6). Electrocardiographic findings were left axis deviation with left ventricular hypertrophy. On echocardiography, there was moderate mitral regurgitation (MR), systolic anterior motion (SAM) of anterior mitral leaflet and prominent systolic narrowing of left ventricle cavity. Transoesophageal echocardiography (TOE) also showed an anomalous muscle bundle stretching into LV causing obstruction. Preload was kept high. Systemic vascular resistance (SVR) was maintained, avoiding use of vasodilators and inotropes. Morrow's septal myectomy was done. Anomalous muscle bundle was excised. On postoperative TOE, there was no MR and no obstruction. Optimal anaesthetic management in such patients involves maintaining adequate preload, systemic vascular resistance and minimal outflow obstruction. Other considerations are to maintain haemodynamic stability, sinus rhythm and afterload. Transoesophageal echocardiography is an extremely useful monitoring device in such patients.

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