Miocardiopatía de y movimiento sistólico anterior de válvula mitral

Abstract

Cardiomyopathy associated with left ventricular outflow tract obstruction (LVOT) is a rare cause of persistent perioperative hypotension. One of the causes of this association is the systolic anterior motion (SAM) of the mitral valve. We report a case of a 67-year-old woman who, after undergoing liver segmentectomy because of metastasis, presents post-operative hypotension that is difficult to manage. Upon evaluation with a transthoracic echocardiogram, the diagnostic suspicion of syndrome associated with LVOT obstruction secondary to SAM was raised. As initial therapy, a volume expander, in association with propanolol and phenylephrine were administred, achieving partial hemodynamic response. Later, she evolved with signs of heart failure and was transferred to the intensive care unit for management. In this unit, non-invasive ventilatory support, diuretic and vasopressor therapy were required, achieving favorable results on the second post-operative day. Echocardiography was essential to make the differential diagnosis against a persistent post-operative hypotension.

Síndrome de Takotsubo tras traumatismo que requiere intervención quirúrgica urgente.

“…Hasta un 20-25% de los pacientes puede desarrollar obstrucción del TSVI y/o IM aguda. Los factores asociados son: edad avanzada, hipertensión arterial, hipertrofia septal, SAM de la válvula mitral e inestabilidad hemodinámica 5 .…”