Hypertrophic Obstructive Cardiomyopathy: Discrepancy Between Hemodynamic Measurements in the Cardiac Laboratory and Operating Room Is to Be Expected
Autor: | Martin D. Abel, Juliano Lentz Carvalho, Jason K. Viehman, Elena Ashikhmina, Jeffrey B. Geske, Hartzell V. Schaff, Brian D. Lahr |
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Rok vydání: | 2022 |
Předmět: |
Operating Rooms
medicine.medical_specialty Supine position medicine.medical_treatment Hemodynamics 030204 cardiovascular system & hematology Ventricular Outflow Obstruction 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Internal medicine medicine.artery Heart Septum medicine Humans Ventricular outflow tract Retrospective Studies business.industry Hypertrophic cardiomyopathy Pulmonary artery catheter Cardiomyopathy Hypertrophic medicine.disease Septal myectomy Treatment Outcome Anesthesiology and Pain Medicine Pulmonary artery Cardiology Mitral Valve Preoperative fasting Laboratories Cardiology and Cardiovascular Medicine business |
Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 36:422-428 |
ISSN: | 1053-0770 |
Popis: | OBJECTIVES It is not uncommon to observe some discrepancy in hemodynamic values characterizing left ventricular outflow tract (LVOT) obstruction preoperatively and in the operating room in patients with hypertrophic obstructive cardiomyopathy. Interpretation of this discrepancy can be challenging. To clarify the extent of the discrepancy, the authors compared hemodynamic variables in patients undergoing septal myectomy at the time of preoperative and intraoperative evaluation. DESIGN Retrospective study. SETTING Single academic medical center. INTERVENTIONS Medical records review, study group-173 patients. MEASUREMENTS AND MAIN RESULTS While there was no statistically significant difference in resting peak LVOT gradients by preoperative transthoracic echocardiography (TTE) compared to intraoperative transesophageal echocardiography (46 mmHg [19-87 mmHg] v 36 mmHg [16-71 mmHg], p = 0.231), the former were higher compared to direct needle-resting LVOT gradient measurements before myectomy (49 mmHg [19-88 mmHg] v 32 mmHg [14-67 mmHg], p = 0.0022). The prevalence of systolic anterior motion was high (94.6% v 91.6%, P = 1.000) both on pre- and intraoperative evaluation. The incidence of moderate/severe mitral was higher intraoperatively (p < 0.0001). Pulmonary artery systolic pressures measured by pulmonary artery catheter provided higher values compared to preoperative TTE estimate (39 mmHg [34-45 mmHg] v 34 mmHg [28-41 mmHg], p < 0.0001). CONCLUSIONS Discrepancy between hemodynamic measurements in the cardiac laboratory and operating room is common and generally should not affect planned patients' care. These changes in hemodynamics might be explained by preoperative fasting, anesthetic agents, volume shifts while supine, and positive-pressure ventilation, as well as the difference in measurement techniques. |
Databáze: | OpenAIRE |
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