RT Book, Section
A1 Wasnick, John D.
A1 Hillel, Zak
A1 Kramer, David
A1 Littwin, Sanford
A1 Nicoara, Alina
SR Print(0)
ID 8551043
T1 Chapter 10. Hypertrophic Obstructive Cardiomyopathy and Cardiac Masses
T2 Cardiac Anesthesia and Transesophageal Echocardiography
YR 2011
FD 2011
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-171798-4
LK accessanesthesiology.mhmedical.com/content.aspx?aid=8551043
RD 2024/04/25
AB Previous  chapters  have  discussed  how  fixed  obstructions  to  blood  flow  through  the  heart  can  lead  to  significant  morbidity  and  mortality.  Aortic  and  mitral  stenosis  are  two  examples  of  lesions,  which  may  prevent  the  heart  from  effectively  pumping  blood.  Hypertrophic  cardiomyopathy  (HCM)  likewise  can  prevent  the  heart  from  pumping  blood  but  in  a  dynamic  rather  than  fixed  way.  With  each  beat  the  hypertrophied  septum  of  the  HCM  patient  together  with  the  anterior  mitral  valve  leaflet  prevent  the  heart  from  ejecting  blood  as  they  obstruct  the  left  ventricular  outflow  tract  (LVOT)  (Figure  10–1).  Hence,  this  condition  in  the  past  was  known  as  hypertrophic  obstructive  cardiomyopathy  (HOCM).  Failure  to  eject  enough  blood  from  the  heart  leads  to  syncope,  dyspnea,  and,  at  times,  sudden  death.  Figure  10–1.Graphic  Jump  LocationView  Full  Size||Download  Slide  (.ppt)The  midesophageal  long-axis  view  is  presented  here  in  outline  form.  As  a  consequence  of  the  hypertrophied  interventricular  septum,  flow  patterns  within  the  heart  are  altered  such  that  the  anterior  leaflet  of  the  mitral  valve  is  drawn  during  ventricular  systole  into  the  LVOT  producing  obstruction.  This  is  known  as  systolic  anterior  motion  of  the  mitral  valve  (SAM).Although  rare,  cardiac  tumors  and  other  masses  can  interfere  with  valve  function,  produce  emboli,  and  dynamically  obstruct  blood  flow  through  the  heart  and  prevent  ejection  into  the  systemic  circulation.  This  chapter  will  examine  these  different  conditions,  which  are  nonetheless  linked  by  their  dynamic  ability  to  prevent  the  heart  from  properly  functioning.