Sadleir Phm, Clarke R C, Lim Bsl, Platt P R
Clinician, WA Anaesthetic Allergy Clinic; Senior Lecturer, Department of Pharmacology, University of Western Australia; Perth, Western Australia.
Clinician, WA Anaesthetic Allergy Clinic; Perth, Western Australia.
Anaesth Intensive Care. 2018 Nov;46(6):566-571. doi: 10.1177/0310057X1804600605.
We describe a case of severe left ventricular outflow tract obstruction (LVOTO) with severe mitral incompetence due to systolic anterior motion of the anterior mitral leaflet (SAM) that was recognised thanks to the immediate availability of transoesophageal echocardiography during the resuscitation of anaphylactic shock. The patient rapidly responded to cessation of the epinephrine (adrenaline) infusion and intravascular volume expansion with intravenous crystalloid. The absence of risk factors for developing SAM/LVOTO serve as a warning to clinicians to consider this diagnosis in all cases of epinephrine non-responsive anaphylactic shock.
我们描述了一例因二尖瓣前叶收缩期前向运动（SAM）导致严重左心室流出道梗阻（LVOTO）并伴有严重二尖瓣反流的病例，该病例是在过敏性休克复苏期间通过即时可用的经食管超声心动图得以确诊。患者在停止肾上腺素输注并静脉输注晶体液进行血管内容量扩充后迅速好转。无发生SAM/LVOTO的危险因素这一情况警示临床医生，在所有对肾上腺素无反应的过敏性休克病例中均应考虑这一诊断。
