Hypertrophic cardiomyopathy part II - Anesthetic and surgical considerations.

ABSTRACT

Hypertrophic cardiomyopathy (HCM) poses many unique challenges regarding the conduct of anesthesia and surgery. Adequate preload, control of sympathetic stimulation, heart rate, and increased afterload are required to decrease the left ventricular outfl ow tract obstruction. Comprehensive intraoperative transesophageal echocardiography (TEE) examination confi rms the diagnosis, elucidates the pathophysiology, and identifi es the various anomalies of mitral valve apparatus and allows assessment of the adequacy of surgery. In this review, we focus on the preoperative assessment, conduct of anesthesia and comprehensive TEE examination of patients presenting for surgery with HCM. The various surgical options are extended myectomy and resection, plication and release.