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CASE REPORT
Year : 2014  |  Volume : 58  |  Issue : 1  |  Page : 51-54

Unexpected refractory intra-operative hypotension during non-cardiac surgery: Diagnosis and management guided by trans-oesophageal echocardiography


Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City 52242, Iowa, USA

Correspondence Address:
Sundara Reddy
6JCP, Department of Anesthesia, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City 52242, Iowa
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5049.126796

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We present a case of severe refractory hypotension in a patient undergoing de-bulking liver resection for massive polycystic liver disease. Emergent trans-oesophageal echocardiography (TOE) revealed dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Notably, he had a structurally normal heart on pre-operative trans-thoracic echocardiography (TTE). Diagnosis of SAM by TOE, possible mechanisms and specific management of refractory hypotension in this context are discussed.


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