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  • CASE: A case of secondary reversible LVOT obstruction
    62 y/o male with a history of hypertension was admitted due to non-small cell lung cancer with stage IIIA.
    • After neoadjuvant concurrent chemoradiation treatment, he underwent left lower lobectomy and mediastinal lymphadenectomy.
    • On his 3rd postoperative day, he developed adult respiratory distress syndrome with shock and was transferred to ICU for mechanical ventilation.
    • Patient was recurrently hypotensive despite vasopressors, and cardiology consultation was done.

    At consultation,
    • Pressure control mode on ventilator
    • v/s: BP 100/80 mmHg, HR 130 RR 20 BT 38.3 °C
    • CVP 4 to 5 cmH2O
    • 3/6 systolic murmur at the left lower sternal border
    • Basilar crackle at both lower lung
    • ECG - NSR, LVH
    • Cardiac enzymes - WNL
    • Medication: Dobutamine 5mcg/kg/min, Dopamine 10mcg/kg/min
    • Echocardiography was performed
    		•
    ▷ LVOT01.avi - The 5-chamber view shows significant SAM with suspicious LVOT obstruction.
    ▷ LVOT02.avi - The 5-chamber view with color Doppler shows mosaic pattern of LVOT flow color Doppler indicated turbulence and increased velocity across the LVOT. Significant MR is also noted briefly.

    		▷ Doppler echocardiography shows markedly increased velocity across LVOT (over 4 m/sec) with late peaking.
    ▷ Significant MR can be seen that has developed due to SAM.
    Patient was diagnosed as LVOT obstruction due to volume contraction and catecholamine infusion
    ▷ Parenteral substitution of crystalloid and colloid was given together with tapering out of the catecholamine treatment
    ▷ The patient improved with disappearance of cardiac murmur and vital sign was stabilized.
    ▷ Follow-up echocardiography was done
    ▷ LVOT03-2.avi - Color Doppler shows disappeared mosaic pattern in LVOT and no significant MR.
    ▷ The LVOT flow velocity is within normal limits with no evidence of late peaking.
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