• CarvalhoJuliano LentzJLDepartment of Cardiovascular Surgery, Mayo Clinic, Rochester, MN., Elena Ashikhmina, Martin D Abel, Jason K Viehman, Brian D Lahr, Jeffrey B Geske, and Hartzell V Schaff.
• Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
• J. Cardiothorac. Vasc. Anesth. 2022 Feb 1; 36 (2): 422-428.

ObjectivesIt is not uncommon to observe some discrepancy in hemodynamic values characterizing left ventricular outflow tract (LVOT) obstruction preoperatively and in the operating room in patients with hypertrophic obstructive cardiomyopathy. Interpretation of this discrepancy can be challenging. To clarify the extent of the discrepancy, the authors compared hemodynamic variables in patients undergoing septal myectomy at the time of preoperative and intraoperative evaluation.DesignRetrospective study.SettingSingle academic medical center.InterventionsMedical records review, study group-173 patients.Measurements And Main ResultsWhile there was no statistically significant difference in resting peak LVOT gradients by preoperative transthoracic echocardiography (TTE) compared to intraoperative transesophageal echocardiography (46 mmHg [19-87 mmHg] v 36 mmHg [16-71 mmHg], p = 0.231), the former were higher compared to direct needle-resting LVOT gradient measurements before myectomy (49 mmHg [19-88 mmHg] v 32 mmHg [14-67 mmHg], p = 0.0022). The prevalence of systolic anterior motion was high (94.6% v 91.6%, P = 1.000) both on pre- and intraoperative evaluation. The incidence of moderate/severe mitral was higher intraoperatively (p < 0.0001). Pulmonary artery systolic pressures measured by pulmonary artery catheter provided higher values compared to preoperative TTE estimate (39 mmHg [34-45 mmHg] v 34 mmHg [28-41 mmHg], p < 0.0001).ConclusionsDiscrepancy between hemodynamic measurements in the cardiac laboratory and operating room is common and generally should not affect planned patients' care. These changes in hemodynamics might be explained by preoperative fasting, anesthetic agents, volume shifts while supine, and positive-pressure ventilation, as well as the difference in measurement techniques.Copyright © 2021 Elsevier Inc. All rights reserved.

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