A 90-year-old patient presenting with postoperative hypotension and a new murmur: a case report.

INTRODUCTION: Hospitalists are frequently consulted on postoperative patients with hypotension. Postoperative hypotension is common and can be due to variety of causes. Systolic anterior motion of the mitral valve leading to left ventricular outflow tract obstruction is a rare cause of postoperative hypotension and can occur without prior structural heart disease. A high index of suspicion can lead to early recognition of this unique condition. CASE PRESENTATION: A 90-year-old Caucasian woman with no known structural heart abnormality was admitted to the intensive care unit with hypotension after a left hip arthroplasty revision. A transthoracic echocardiogram revealed systolic anterior motion of the mitral valve and dynamic left ventricular outflow tract obstruction as the likely cause of her hypotension. Our patient was treated with fluid resuscitation and phenylephrine with improvement in blood pressure. A repeat echocardiogram on postoperative day 5 showed resolution of the left ventricular outflow tract obstruction. Intraoperative vasodilatation and volume loss that caused underfilling of the left ventricle likely led to dynamic outflow tract obstruction in our patient. CONCLUSIONS: Hospitalists should be aware of systolic anterior motion of the mitral valve as a rare peri-operative complication in patients with or without underlying cardiac pathology as it is treated differently than other causes of peri-operative hypotension. Clinical suspicion, early recognition, and prompt treatment can improve clinical outcomes in these patients.

Simultaneous treatment of native coarctation of the aorta combined with patent ductus arteriosus using a covered stent.

A 19-year-old girl with coarctation of the aorta and patent ductus arteriosus underwent simultaneous treatment of native coarctation and closure of ductus arteriosus using a covered Cheatham-Platinum stent. This technique may be used as an alternative to other forms of interventional therapy or surgery for this combination of lesions in adolescents and adults.

Insuficiencia valvular mitral y comunicación interauricular post comisurotomía mitral percutánea: revisión crítica y significación clínica de estas complicaciones / Residual mitral valve insufficiency and atrial septal defect, post percutaneous mitral commisurotomy critical: review clinical significance of the complications

El presente trabajo fue realizado con la finalidad de evaluar, por medio de la ecocardiografia Doppler a color transtorácica la magnitud y evolución de la insuficiencia valvular mitral y de la comunicación interauricular residuales, post comusurotomía mitral percutánea (CMP). Se estudiaron 15 pacientes sometidos a este procedimiento. En 11 de las 15 pacientes (73,3 por ciento) hubo aparición o aumento de una regurgitación mitral por ventriculografia, inmediatamente despues de la CMP. Sólo 2 casos presentaron insuficiencia severa y ningún paciente ha requerido cirugía. La ecocardiografia demostró que de las 11 pacientes que presentaron regurgitación mitral en 5 de ellas (45,5 por ciento) disminuyó el grado de regurgitación a los 20,1 meses promedio de seguimiento. La aparición de comunicación interauricular inmediatamente después del procedimiento, se detectó por oximetría en 3 pacientes (20 por ciento)