[Hypertrophic cardiomyopathy].

Abstract

A 68-year-old woman with severe cardiac dysfunction due to dilated phase of hypertrophic cardiomyopathy was diagnosed with sigmoid cancer and scheduled for high anterior resection. Preoperative left ventricular ejection fraction (EF) was 16% by transthoracic echocardiography. After placement of an epidural catheter at the T12-L1 interspace, and artery catheters in the left radial artery for invasive blood pressure monitoring and in the right femoral artery for stand-by IABE general anesthesia was induced by midazolam, fentanyl and sevoflurane, and maintained with sevoflurane. Analgesia was obtained by epidural administration of 1% lidocaine and 0.2% ropivacaine. A central venous catheter was placed in the right internal jugular vein through which dobutamine was infused throughout the operation. Cardiac function monitored by transesophageal echocardiography showed EF of 9% just after insertion. After arbitrary administration of phenylephrine and landiolol, the operation and anesthesia were completed without serious problems. However, congestive heart failure worsened on postoperative day 2, and was improved by increasing dobutamine and by administration of milrinone.