Anaesthesia management of a Patient with Hypertrophic Obstructive Cardiomyopathy Undergoing c2-c5 Decompression in Cervical Myelopathy
DOI:
https://doi.org/10.51985/JBUMDC2025785Keywords:
Cervical Spondylotic Myelopathy, Hypertrophic Obstructive cardiomyopathy (HOCM), Perioperative careAbstract
Hypertrophic obstructive cardiomyopathy (HOCM) presents unique challenges in perioperative management due to its
dynamic left ventricular outflow tract obstruction, diastolic dysfunction, and susceptibility to arrhythmias. This report
highlights the anesthetic considerations in an 80-year-old female with HOCM and cervical spondylotic myelopathy
undergoing C2-C5 decompressive surgery. The patient, an ASA-III with poorly controlled hypertension, experienced acute
hemodynamic instability post-induction, necessitating emergent optimization. Re-attempted surgery under transesophageal
echocardiography guidance, invasive hemodynamic monitoring, and tailored anesthetic techniques ensured uneventful
completion. This case underscores the critical role of echocardiographic assessment, precise fluid management, and
pharmacological strategies in minimizing perioperative risks in HOCM patients. The report aims to contribute to the limited
literature on HOCM anesthetic management and to guide clinicians facing similar complexities
References
1. Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott
P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel
C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake
CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC
guideline for the diagnosis and treatment of patients with
hypertrophic cardiomyopathy: executive summary: a report
of the American College of Cardiology/American Heart
Association Joint Committee on Clinical Practice Guidelines.
Circulation. 2020;142(25):e533–e557. doi:10.1161/CIR.
0000000000000938.
2. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi
F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt
H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S,
Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C,
Watkins H. 2014 ESC guidelines on diagnosis and management
of hypertrophic cardiomyopathy: the Task Force for the
Diagnosis and Management of Hypertrophic Cardiomyopathy
of the European Society of Cardiology (ESC). Eur Heart J.
2014;35(39):2733–79. DOI:https://doi.org/10.1093/
eurheartj/ehu284
3. Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet.
2013;381(9862):242–55. DOI:https://doi.org/10.1016/S0140-
6736(12)60397-3
4. Lebowitz S, Kowalewski M, Raffa GM, Chu D, Greco M,
Gandolfo C, Mignosa C, Lorusso R, Suwalski P, Pilato M.
Review of contemporary invasive treatment approaches and
critical appraisal of guidelines on hypertrophic obstructive
cardiomyopathy: state-of-the-art review. J Clin Med.
2022;11(12):3405. DOI:https://doi.org/10.3390/jcm11123405
5. Maurizi N, Antiochos P, Owens A, Lakdawala N, Saberi S,
Russell MW, et al. Long-term outcomes after septal reduction
therapies in obstructive hypertrophic cardiomyopathy: insights
from the SHARE Registry. Circulation. 2024 Oct
22;150(17):1377–90. doi:10.1161/CIRCULATIONAHA.
124.069378.
6. Basit H, Alahmadi MH, Rout P, et al. Hypertrophic
cardiomyopathy [Internet]. Updated 2024 Jun 7. In: StatPearls.
Treasure Island (FL): StatPearls Publishing; 2025 Jan –.
Available from: https://www.ncbi.nlm.nih.gov/books/
NBK430788/
7. Chou CJ, Lai YC, Ou SY, Chen LC, Huang JH, Chen YW,
Wu CY. Unexpected systolic anterior motion of the mitral
valve-related hypoxemia during transurethral resection of the
prostate under spinal anesthesia: a case report. BMC
Anesthesiol. 2022;22(1):207. doi:10.1186/s12871-022-01754-
x.
8. Ahmed A, Zaidi RA, Hoda MQ, Ullah H. Anesthetic
management of a patient with hypertrophic obstructive
cardiomyopathy undergoing modified radical mastectomy.
Middle East J Anaesthesiol. 2010;20(5):739-742.
9. Cunningham JJ, Braun AS, Hussey P, Momaya A, Kukreja
P. Regional anesthesia for arthroscopic knee repair in a patient
with hypertrophic obstructive cardiomyopathy (HOCM) under
monitored anesthesia care with dexmedetomidine infusion.
Cureus. 2024;16(2):e53862. DOI:https://doi.org/10.7759/
cureus.53862
10. Bhave A, Mohan G, Couture L, Sharma G, Yirerong J.
Multidisciplinary approach to management of hypertrophic
cardiomyopathy with severe left ventricular outflow obstruction
in pregnancy. JACC Case Rep. 2023;27:102057. DOI:https://
doi.org/10.1016/j.jaccas.2023.102057
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Copyright (c) 2026 Sayed Makarram Ahmed Bukhari, Atif Nazir (Author)
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