Document Type

Article

Peer Reviewed

1

Publication Date

1-1-2014

NLM Title Abbreviation

J Med Case Rep

Journal/Book/Conference Title

Journal of Medical Case Reports

PubMed ID

25384414

DOI of Published Version

10.1186/1752-1947-8-363

Abstract

Introduction Hospitalists are frequently consulted on postoperative patients with hypotension. Postoperative hypotension is common and can be due to variety of causes. Systolic anterior motion of the mitral valve leading to left ventricular outflow tract obstruction is a rare cause of postoperative hypotension and can occur without prior structural heart disease. A high index of suspicion can lead to early recognition of this unique condition. Case presentation A 90-year-old Caucasian woman with no known structural heart abnormality was admitted to the intensive care unit with hypotension after a left hip arthroplasty revision. A transthoracic echocardiogram revealed systolic anterior motion of the mitral valve and dynamic left ventricular outflow tract obstruction as the likely cause of her hypotension. Our patient was treated with fluid resuscitation and phenylephrine with improvement in blood pressure. A repeat echocardiogram on postoperative day 5 showed resolution of the left ventricular outflow tract obstruction. Intraoperative vasodilatation and volume loss that caused underfilling of the left ventricle likely led to dynamic outflow tract obstruction in our patient. Conclusions Hospitalists should be aware of systolic anterior motion of the mitral valve as a rare peri-operative complication in patients with or without underlying cardiac pathology as it is treated differently than other causes of peri-operative hypotension. Clinical suspicion, early recognition, and prompt treatment can improve clinical outcomes in these patients.

Keywords

OAfund, Postoperative hypotension, Dynamic left ventricular outflow tract obstruction

Journal Article Version

Version of Record

Published Article/Book Citation

Journal of Medical Case Reports 2014, 8:363 doi:10.1186/1752-1947-8-363

Rights

Copyright: © 2014 Hartog and Kamath; licensee BioMed Central Ltd. Posted by permission.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

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URL

https://ir.uiowa.edu/internalmedicine_pubs/3