Systolic Anterior Motion of the Mitral Valve with Left Ventricular Outflow Tract Obstruction: Three Cases of Acute Perioperative Hypotension in Noncardiac Surgery

In Brief In this report we describe three cases of severe perioperative hypotension in noncardiac surgery patients. As systolic anterior motion of the mitral valve in combination with subaortic left ventricular outflow tract obstruction is an unrecognized cause for hypotension in noncardiac surgery patients, delayed diagnosis can result in erroneous treatment regimen. The aim of the present report is to provide an informative and brief synopsis of the pathophysiological consequences and diagnostic/therapeutic strategies for the perioperative management of systolic anterior motion. IMPLICATIONS: Systolic anterior motion of the mitral valve with left ventricular outflow obstruction and mitral regurgitation may be an unrecognized cause of acute, perioperative cardiovascular collapse. Acute treatment of perioperative systolic anterior motion of the mitral valve includes volume infusion and application of vasopressors. In selective cases, use of β-blockers is indicated.