Elaiopoulos D, Dimitriadis F, Tzatzaki E, Chronaki M, Kolonia K, Antonopoulos M, Konstantinou G, Kogerakis N, Dimopoulos S. Vasopressin role in hypertrophic obstructive cardiomyopathy post-cardiac surgery: A case report. World J Crit Care Med 2025; 14(4): 106485 [DOI: 10.5492/wjccm.v14.i4.106485]
Corresponding Author of This Article
Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Syggrou Avenue, Athens 17674, Attikí, Greece. stdimop@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 9, 2025
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Journal Information of This Article
Publication Name
World Journal of Critical Care Medicine
ISSN
2220-3141
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Elaiopoulos D, Dimitriadis F, Tzatzaki E, Chronaki M, Kolonia K, Antonopoulos M, Konstantinou G, Kogerakis N, Dimopoulos S. Vasopressin role in hypertrophic obstructive cardiomyopathy post-cardiac surgery: A case report. World J Crit Care Med 2025; 14(4): 106485 [DOI: 10.5492/wjccm.v14.i4.106485]
Dimitrios Elaiopoulos, Fotios Dimitriadis, Eleni Tzatzaki, Maria Chronaki, Konstantina Kolonia, Michalis Antonopoulos, Giorgos Konstantinou, Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens 17674, Attikí, Greece
Nektarios Kogerakis, Department of Cardiac Surgery II, Onassis Cardiac Surgery Center, Athens 17674, Attikí, Greece
Author contributions: Elaiopoulos D, Dimitriadis F, and Tzatzaki E contributed to the manuscript writing and editing; Chronaki M, Kolonia K, Antonopoulos M, Konstantinou G, and Kogerakis N contributed to data collection, analysis, and conceptualization; Dimopoulos S contributed to supervision. All authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Stavros Dimopoulos, Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 356 Syggrou Avenue, Athens 17674, Attikí, Greece. stdimop@gmail.com
Received: March 13, 2025 Revised: May 5, 2025 Accepted: July 23, 2025 Published online: December 9, 2025 Processing time: 260 Days and 7.8 Hours
Abstract
BACKGROUND
Managing left ventricular outflow tract obstruction (LVOTO) and systolic anterior motion (SAM) of the mitral valve can be challenging, especially in the context of circulatory shock and pulmonary edema post cardiac surgery.
CASE SUMMARY
We describe a case of an 80-year-old female patient with a history of severe aortic stenosis and hypertrophic obstructive cardiomyopathy that underwent aortic valve replacement and myectomy. The patient presented with acute pulmonary edema and low blood pressure due to LVOTO and SAM post cardiac surgery in the intensive care unit. She was paced with an epicardial dual-chamber pacing system due to complete atrioventricular block and treated initially with norepinephrine, furosemide, and esmolol infusion and continuous positive pressure ventilation. The patient remained hypoxemic and kept deteriorating hemodynamically despite titrating up norepinephrine. The addition of vasopressin infusion and tapering of norepinephrine finally stabilized the patient with significant reduction of LVOTO, confirmed by transthoracic echocardiography assessment, improved oxygenation and increased urine output.
CONCLUSION
Vasopressin seems to be the preferred vasopressor for managing LVOTO and SAM post-cardiac surgery, because of its absence of inotropic effects. Echocardiography is crucial for early diagnosis and therapeutic management.
Core Tip: Left ventricular outflow tract (LVOT) obstruction is a condition in which the LVOT is obstructed. Aortic valve stenosis and hypertrophic cardiomyopathy are the most common causes of LVOT obstruction. We report a case of severe aortic stenosis and hypertrophic obstructive cardiomyopathy that underwent aortic valve replacement and myectomy. Management of patients with hypertrophic obstructive cardiomyopathy and systolic anterior motion remains a clinical challenge. Bedside echocardiogram guided therapeutic decisions has central role in such complex case patients to improve outcome. Vasopressin has been shown to reduce LVOT gradient and seems to be the vasoconstrictive drug of choice in such patients.
