Recognizing non-compaction cardiomyopathy in anesthetic practice: perioperative implications and management strategies

Background: Non-compaction cardiomyopathy is a rare and potentially serious form of primary cardiomyopathy characterized by prominent myocardial trabeculations and deep recesses resulting from a defect in embryonic myocardial compaction. Clinically, it can manifest with heart failure, potentially lethal arrhythmias, and thromboembolic events. It is frequently underdiagnosed, thus posing a high risk during anesthetic procedures. Objective: The objective of this mini narrative review is to highlight the importance of preoperative recognition of non-compaction cardiomyopathy by the anesthesiologist, highlighting its clinical implications in the perioperative period and the available anesthetic management strategies. Conclusion: Preoperative identification of non-compaction cardiomyopathy allows the anesthesiologist to adopt specific and individualized strategies, such as detailed cardiological evaluation, advanced hemodynamic monitoring, and careful choice of anesthetic agents that minimize changes in myocardial contractility. Cases with ventricular dysfunction or arrhythmias require additional care, including inotropic support, availability of defibrillation, and thromboembolic prophylaxis. The use of intraoperative transesophageal echocardiography has been useful in more complex procedures. Knowledge of non-compaction cardiomyopathy is essential for safe anesthetic practice, and consequently, appropriate management can significantly reduce the risk of intraoperative and postoperative complications, improving the prognosis for these patients.