This report reviews current knowledge concerning the pathophysiology, hemodynamics, and perioperative management of hypertrophic cardiomyopathy (HCM). HCM is a primary myocardial disease that causes ventricular hypertrophy. This condition occurs in at least 1 per 200 individuals in the general population, and many patients with HCM have a family history of HCM inherited in an autosomal dominant pattern. HCM can cause atrial fibrillation, heart failure, and sudden death with ventricular fibrillation. The incidence of perioperative complications increases in correlation with moderate or severe mitral regurgitation, significant left ventricular outflow tract (LVOT) pressure gradient, heart failure with reduced ejection fraction (EF), and heart failure with preserved EF. Patients with HCM should be handled in a manner similar to that used in case of patients with aortic stenosis. The management of hemodynamic status ranges from minimally invasive monitoring for mild cases to monitoring using transesophageal echocardiography (TEE) for severe cases. TEE is useful for patients with HCM as it can evaluate morphometric images and systolic and diastolic function. The severity of HCM and LVOT obstruction is correlated with the incidence of cardiovascular complications. Perioperative management should also be based on the pathophysiological knowledge of HCM.

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Pulmonary artery sarcoma is a rare neoplasm with poor prognosis. Surgical resection may be performed, but the fatal hemodynamic collapse can occur during anesthesia induction. Case: A 70-year-old man felt dyspnea 3 months before the surgery. The space-occupying lesion in the pulmonary trunk was found, but his hemodynamics was maintained with 0.5 µg/kg/min of dobutamine, and the NYHA functional class was III. During induction of anesthesia, his hemodynamics collapsed, and the VA-ECMO (veno-arterial extracorporeal membrane oxygenation) was applied. The operation was performed, but the VA-ECMO was needed to maintain his hemodynamics after cardiopulmonary bypass, and he died on post-operative day 7. Prediction of hemodynamic collapse preoperatively is difficult. Therefore, the choice of anesthetic agents should be considered which would not change the systemic vascular resistance like ketamine. And also, noradrenaline should be used to maintain systemic vascular resistance and prevent hemodynamic collapse. Moreover, sheaths should be placed before induction of anesthesia so that VA-ECMO can be installed immediately when hemodynamic collapse occurs.

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Ophthalmic surgery belongs to a low risk group for perioperative cardiac complication. A 70s year-old male received a right ophthalmectomy for conjunctival spinous cell carcinoma with general anesthesia. No remarkable findings was on his preoperative examination. During the operation, a bundle branch block and ST elevation were occurred. After the operation, he felt chest discomfort and ST re-elevated. He was treated for acute coronary syndrome Type-I due to plaque and thrombus. Although we estimated that his preoperative physical condition was good, it was found that he felt chest pain some times by the further interview. Accurate preoperative evaluation might indicate the risk of cardiac complication.

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