Perioperative Anesthetic Management of a Case with Severe Dilated Cardiomyopathy

Oman Medical Journal 02/2010; 25(1). DOI: 10.5001/omj.2010.20

ABSTRACT Dilated cardiomyopathy (DCM) is characterized by dilatation and impaired systolic function of one or both ventricles. Five to eight people per 100,000 develop this disorder each year. It is more common in men. Malignant arrhythmias are the most common cause of death in DCM1. Around 50% of cases of nonischaemic dilated cardiomyopathy are idiopathic. Other causes are familial, infectious, infiltrative and connective tissue diseases. This is a report of successful anesthetic management of a patient with severe DCM undergoing a surgical procedure using combined thoracic epidural analgesia (TEA) and general anesthesia (GA).

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    ABSTRACT: A 42-year-old woman, who presented with DCM (American Society of Anesthesia, ASA class IV), suffered from gallstone for years, and was scheduled for laparoscopic cholecystectomy. Echocardiography demonstrated a severely dilated left ventricle with global hypokinesia and reduction of left ventricular systolic function, ejection fraction (EF) 34% with mild mitral regurgitation and severe tricuspid regurgitation. After intubation, a transesophageal echocardiography (TEE) probe was inserted. When the IAP was gradually ascended to 14 mmHg during the laparoscopy, EF fell to 19% and the systolic pressure fell to 78 mmHg and TEE showed severely poor wall motion. But the central venous pressure (CVP) still showed about 4 mmHg throughout the whole procedure. After decreasing the IAP to 10 mmHg, we adjusted the rate of pacemaker to 70 times per minute then the systolic pressure was kept at around 100 mmHg, and the diastolic pressure was kept at 60 mmHg. EF was 30% after the reduction of IAP and the adjusting of the heart rate set. TEE is a helpful monitor in anesthesia management of patients with DCM during noncardiac surgery and CVP is useless especially for the procedure with severe hemodynamic effects.
    Pakistan Journal of Medical Sciences Online 04/2013; 29(2):675-7. · 0.10 Impact Factor
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    ABSTRACT: Idiopathic dilated cardiomyopathy is a primary myocardial disease with unknown aetiology. This disease follows a prospective course that is characterized by ventricular dilation and impaired myocardial dilation. Congestive heart failure and malignant arrhythmias are the most widespread complications. The incidence of idiopathic dilated cardiomyopathy in the general population is 5-8/100.000. Because of the increased risks of perioperative complications, anesthetic management of this disease requires the application of a specific technique. This case report demonstrates the application of successful regional anesthetic management (thoracic epidural anesthesia) in a patient who had been diagnosed with severe idiopathic dilated cardiomyopathy.
    Medical Archives 01/2014; 68(2):144-6.

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