Anaesthetic Management Of A Patient With Hocm For Abdominal Surgery

Hypertrophic obstructive cardiomyopathy(HOCM) is a unique genetic cardiac disorder charecterised by sudden death due to left ventricular outflow tract obstruction.Anaesthesiologists may be confronted with clinically unrecognised HOCM and should be prepared to manage the haemodynamic challenges for successful perioperative outcome.

A 62 year old female patient with enterocutaneous fistula following surgery for incisional hernia presented to us for repair.she was a known hypertensive on treatment and on preoperative evaluation we incidentally diagnosed her with HOCM and chronic renal failure.This patient was taken up for surgery under lumbar epidural anaesthesia under ASA III.

A review of literature showed that cases of HOCM presenting for non cardiac surgery have been successfully managed with general anaesthesia and occasional reports of regional anaesthesia techniques.This patient had additional comorbity in the form of chronic renal failure, hence to avoid the stress response and polypharmacy associated with GA and the fluid shifts associated with GA and spinal anaesthesia ,we chose graded lumbar epidural technique.