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Transesophageal Echocardiography-guided Anesthetic Management for Laparoscopic Cholecystectomy in a Patient with Left Ventricular Outflow Tract Obstruction: A Case Report
Xiao Xiao1*, Qianqian Tang1, Mengmeng Zhou1
1Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 China
Corresponding Author: Xiao Xiao
Address: Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Received date: 03 June 2025; Accepted date: 12 June 2025; Published date: 19 June 2025
Citation: Xiao X, Tang Q, Zhou M. Transesophageal Echocardiography-guided Anesthetic Management for Laparoscopic Cholecystectomy in a Patient with Left Ventricular Outflow Tract Obstruction: A Case Report. Asp Biomed Clin Case Rep. 2025 Jun 19;8(2):118-21.
Copyright © 2025 Xiao X, Tang Q, Zhou M. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Transesophageal Echocardiography, Left Ventricular Outflow Tract Obstruction, Laparoscopic Cholecystectomy, Anesthesia
Abbreviations: LVOT: Left Ventricular Outflow Tract; SAM: Systolic Anterior Motion; TEE: Transesophageal Echocardiography; HCM: Hypertrophic Cardiomyopathy; SVR: Systemic Vascular Resistance
Abstract
Background: Left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the mitral valve poses significant perioperative risks during non-cardiac surgery. Transesophageal echocardiography (TEE) plays a critical role in real-time hemodynamic monitoring and management of such patients.
Case Presentation: A 76-year-old female (54 kg) with suspected hypertrophic cardiomyopathy, diagnosed with LVOT obstruction (Vmax = 3.9 m/s, PG = 59 mm Hg) and SAM, underwent laparoscopic cholecystectomy under general anesthesia. TEE-guided management included:
1. Pre-induction fluid resuscitation (500 mL succinylated gelatin) to optimize preload.
2. Anesthetic induction with midazolam, sufentanil, cisatracurium, and propofol, combined with a continuous norepinephrine infusion (0.05 ÎĽg/kg/min) to maintain systemic vascular resistance without increasing contractility.
3. Intraoperative TEE monitoring of LVOT obstruction and SAM severity during reverse Trendelenburg positioning and CO₂ pneumoperitoneum (12 cm H₂O). Fluid therapy and vasopressor titration were adjusted based on TEE findings to maintain hemodynamic stability (BP 110–140/50–90 mm Hg, HR 60–80 bpm).
4. Postoperative pain control with oxycodone and tracheal lidocaine inhalation to prevent sympathetic surges during extubation.
Conclusion: TEE-guided anesthesia management effectively mitigated the exacerbation of LVOT obstruction in this high-risk patient, highlighting its value in optimizing perioperative hemodynamics in cases of LVOT obstruction with SAM.