What monitoring would be required in HOCM patients?

What monitoring would be required in HOCM patients?

Patients with HOCM may be extremely sensitive to slight changes in ventricular volume, blood pressure, heart rate, and rhythm. Accordingly, monitoring should allow for continuous assessment of these parameters, particu-larly in patients with severe obstruction. In patients with HOCM coming to surgery for septal myomectomy, the electrocardiogram (ECG), an intra-arterial catheter, and a central venous catheter are necessary. Many anesthetists would also use a pulmonary artery catheter. Two-dimensional transesophageal echocardiography (TEE) provides useful data on ventricular performance, the dynamic mechanism of the LVOT obstruction, and the accompanying mitral regurgitation. After septal myomectomy, TEE provides invaluable information about residual obstruction and mitral regurgitation. It can also be useful for the detection of surgical complications, such as ventricular septal perforation. TEE should certainly be employed if the equipment and trained personnel are available.

In patients with HOCM coming for other procedures, monitoring should provide some indication of ventricular volume, force of ventricular contraction, and transmural pressure distending the outflow tract. Central venous pres-sure should be an adequate indicator of ventricular volume in procedures that do not result in major volume shifts or alterations in ventricular function. An intra-arterial catheter is almost always indicated for beat-to-beat obser-vation of ventricular ejection during major regional or general anesthesia in patients with symptomatic HOCM. Intraoperative TEE is the most accurate monitor of ven-tricular loading conditions and performance in HOCM and its use will certainly increase as more centers have the means to employ this type of monitoring.