Date: 22 Oct 2009

Always consider left ventricular outflow tract obstruction in hemodynamically unstable patients

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Transesophageal echocardiography (TEE) plays a key role in the evaluation of hemodynamic instability, particularly in the diagnosis of left ventricular outflow tract obstruction (LVOTO) where it can completely alter patient management. The purpose of these rounds is to highlight how TEE can be instrumental in ensuring a timely diagnosis of this lesion by using examples from the recent archives of the Montreal Heart Institute of hemodynamic instability secondary to previously undiagnosed LVOTO. In some cases, TEE can also serve as an invaluable tool to evaluate the response to therapy in the perioperative and critical care settings. The Research Ethics Committee of the Montreal Heart Institute granted approval for use of the related images for research and publication purposes.

Case 1

An elderly male with coronary artery disease was scheduled for coronary artery bypass surgery. His primary symptom was dyspnea, and his medical history was notable for systemic hypertension. Following induct ...