Contribution of Adequate Preoperative Circulatory Management to Uneventful Perioperative Course of Transurethral Resection of a Bladder Tumor for a Patient with Hypertrophic Obstructive Cardiomyopathy

Key Result

Preoperative pharmacological therapy with carvedilol and cibenzoline reduced the resting LVOT gradient from 81 mmHg to 43 mmHg, enabling an uneventful transurethral resection of a bladder tumor.

Key Points

• To evaluate the role of preoperative circulatory management in the perioperative safety of bladder tumor surgery for a patient with hypertrophic obstructive cardiomyopathy.
• Case report of a 67-year-old man with hypertrophic obstructive cardiomyopathy scheduled for TUR-Bt.
• Initial evaluation revealed a left ventricular outflow tract gradient of 81 mmHg, leading to surgery postponement.
• Preoperative pharmacological therapy was initiated using carvedilol and cibenzoline to reduce LVOT gradient.
• Spinal anesthesia combined with obturator nerve block was chosen for anesthetic management during surgery.
• Continuous monitoring of arterial blood pressure took place throughout the procedure.
• The initial LVOT gradient decreased from 81 mmHg to 41 mmHg after pharmacological therapy.
• The TUR-Bt proceeded without complications after rescheduling.
• Postoperative intervention included percutaneous transluminal septal myocardial ablation, reducing the LVOT gradient to 3 mmHg.