Two cases of left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve due to valvular cardiomyopathy during operation

We report two cases of left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of anterior mitral valve due to specific (secondary) cardiomyopathy during operation. The LVOT obstructions occurred and led to hypotension just after the induction of anesthesia in one case, and following the administration of nicardipine in another case. In both cases, preoperative diagnosis of the specific cardiomyopathy was not made. We revealed the LVOT obstruction with SAM using a transesophageal echocardiography (TEE) when the unstable hemodynamics developed. After the operations the valvular cardiomyopathy without LOVT obstruction was diagnosed by a cardiologist. Careful management is required including the TEE monitoring when we anesthetize a patient who is complicated not only with idiopathic cardiomyopathy but also with specific cardiomyopathy such as valvular or hypertensive cardiomyopathy because both types of cardiomyopathy develop LVOT obstruction with SAM in some pathophysiological conditions during operation.