“Systolic anterior motion” (SAM): Una causa infrecuente de hipotensión severa en el perioperatorio de cirugía no cardíaca.

Resumen

SYSTOLIC ANTERIOR MOTION. A REPORT OF TWO CASES

Systolic anterior motion describes the anterior displacement of one or both mitral valve leaflets, obstructing the outflow tract of the left ventricle. It can be a cause of severe hypotension during the intraoperative and postoperative period of non-cardiac surgery. The diagnosis is made with echocardiography. We report two patients with this problem. The first was a 74 year old male subjected to an incisional hernia repair that presented severe hypotension in the intraoperative period. An echocardiography revealed an anterior displacement of the mitral valve anterior leaflet. Epinephrine was discontinued and Norepinephrine and a volume expander were administered, with good response. The second patient was a 64 year old male undergoing a right liver lobectomy. In the postoperative period, he suffered severe hypotension. An transesophageal echocardiography revealed an anterior displacement of the mitral valve anterior leaflet. Dobutamine was discontinued, volume was administered, and a Norepinephrine infusion was started with good response.