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Seminars in Cardiothoracic and Vascular Anesthesia

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https://www.readbyqxmd.com/read/30404582/percutaneous-intervention-after-previous-mitral-valve-surgery-implications-for-the-perioperative-anesthesiology-proceduralist
#1
Charles B Nyman, Douglas C Shook, Stanton Shernan
The advent of percutaneous therapies has significantly altered therapeutic options for patients with valvular heart disease. Building on the success of transcatheter aortic valve replacement, both expanded indications and purpose-built devices are now being used to address percutaneous approaches for mitral valve pathology. While surgical mitral valve repair remains the gold standard for addressing significant mitral valve pathology, there has been a progressive increase in the utilization of bioprosthetic valves despite their limited lifespan...
November 8, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30382771/functional-tricuspid-regurgitation-in-mitral-valve-disease
#2
Sharon L McCartney, Bradley S Taylor, Alina Nicoara
Functional tricuspid regurgitation is a common finding in patients with left-sided heart disease. If left untreated, it may reduce survival, limit functional capacity and cause end-organ dysfunction. Annulus dilation and leaflet tethering due to right ventricle remodeling are 2 major pathophysiologic mechanisms in functional tricuspid regurgitation. Even if surgical treatment remains the gold standard, indication and timing of surgical interventions remain the object of debate in the medical community. More recently, numerous transcatheter therapies have been developed in order to offer less invasive options to patients who otherwise would have a high risk of mortality and morbidity with surgical interventions...
November 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30264660/a-systematic-review-of-caudal-anesthesia-and-postoperative-outcomes-in-pediatric-cardiac-surgery-patients
#3
Malak Maharramova, Katherine Taylor
OBJECTIVES: In pediatric cardiac surgery, does caudal anesthesia promote early extubation, reduce pain scores, reduce stress responses, and length of stay (LOS)? DESIGN: A systematic review. PARTICIPANTS: Inclusion criteria included cardiac surgical procedures (with or without cardiopulmonary bypass) in any subject between the ages of full-term newborn and 18 years receiving caudal anesthesia of any medication combination. Searches were conducted with assistance of an Academic librarian from 1947 to July 2017...
September 28, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30229690/right-ventricular-function-in-left-heart-disease-relevance-to-the-mitral-valve
#4
J Mauricio Del Rio, Loreta Grecu, Alina Nicoara
Right ventricular (RV) function is an independent prognostic factor for short- and long-term outcomes in cardiac surgical patients. Patients with mitral valve (MV) disease are at increased risk of RV dysfunction before and after MV operations. Yet RV function is not part of criteria for decision making or risk stratification in this setting. The role of MV disease in the development of pulmonary hypertension (PHTN) and the ultimate impact of PHTN on RV function have been well described. Nonetheless, there are other mechanisms by which MV disease and MV surgery affect RV performance...
September 19, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30063197/thomas-bevill-peacock-and-the-first-descriptions-of-congenital-heart-disease
#5
EDITORIAL
Mark D Twite, Miklos D Kertai, Nathaen Weitzel
No abstract text is available yet for this article.
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29808750/perioperative-and-anesthetic-considerations-in-truncus-arteriosus
#6
Rishi Parikh, Michael Eisses, Gregory J Latham, Denise C Joffe, Faith J Ross
Truncus arteriosus is a congenital cardiac lesion in which failure of embryonic truncal septation results in a single semilunar valve and single arterial trunk providing both pulmonary and systemic circulations. Most patients with this lesion are symptomatic in the neonatal period with cyanosis and/or congestive heart failure and undergo complete repair in the first weeks of life. This review will focus on the anatomy, physiology, and perioperative anesthetic management of patients with truncus arteriosus.
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29774793/surgical-considerations-in-interrupted-aortic-arch
#7
Damien J LaPar, Christopher W Baird
Interrupted aortic arch (IAA) is a rare congenital anomaly with several anatomical variants and is often associated with other intracardiac and/or extracardiac congenital anomalies. Historically, associated with high early mortality, outcomes for this anomaly have improved in recent eras with advances in perioperative and anesthesia management and refinements in surgical technique. This review provides a description of surgical anatomy, anatomical classifications, and associated congenital lesions as well as an examination of the perioperative and surgical management of IAA in the contemporary surgical era...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29742969/perioperative-and-anesthetic-considerations-in-interrupted-aortic-arch
#8
Nelson Burbano-Vera, Katherine L Zaleski, Gregory J Latham, Viviane G Nasr
Interrupted aortic arch (IAA) is defined as the loss of luminal continuity between the ascending and descending aorta and is classified based on the anatomic level of interruption. IAA is associated with a number of intracardiac anomalies with the most common being patent ductus arteriosus, ventricular septal defect, and left ventricular outflow obstruction. There is also a strong association between type B interruption and 22q11 deletion syndrome. The perioperative management of the neonate with IAA begins in the intensive care unit with optimization of end-organ perfusion and function...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29717916/risk-factors-associated-with-the-development-of-acquired-airway-disease-after-congenital-heart-surgery-a-retrospective-cohort-study
#9
Andrew J Matisoff, Pranathi Ari, David Zurakowski, Alexandra G Espinel, Nina Deutsch, Brian K Reilly
OBJECTIVE: In this single-center, retrospective review, we sought to determine the risk factors associated with the development of severe acquired airway disease (AAD; vocal cord paralysis [VCP] or subglottic stenosis [SGS]) in pediatric patients who had undergone surgery for congenital heart disease (CHD) with cardiopulmonary bypass. All patients who required surgical treatment for CHD using cardiopulmonary bypass at our institution between 2010 and 2015 were reviewed. We defined severe AAD as either clinically significant VCP, SGS, or both, requiring consultation with the otolaryngology (ENT) service for evaluation...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29649938/preoperative-physiology-imaging-and-management-of-interrupted-aortic-arch
#10
Kevin Friedman
Interrupted aortic arch (IAA) is a rare form of critical neonatal heart disease in which there is lack of continuity between the ascending aorta and the descending thoracic aorta. In the absence of prenatal diagnosis, patients with IAA present in shock when the patent ductus arteriosus closes. Diagnosis can generally be made by echocardiography, and initiation of prostaglandin E1 infusion allows for adequate lower body perfusion prior to surgical repair. Full neonatal repair can be achieved with good outcomes in most cases...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29411679/pulmonary-atresia-with-an-intact-ventricular-septum-preoperative-physiology-imaging-and-management
#11
Sathish M Chikkabyrappa, Rohit S Loomba, Justin T Tretter
Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare complex cyanotic congenital heart disease with heterogeneous morphological variation. Prenatal diagnosis allows for developing a safe plan for delivery and postnatal management. While transthoracic echocardiography allows for detailed delineation of the cardiac anatomy, additional imaging modalities such as computed tomography, magnetic resonance imaging, and catheterization may be necessary to further outline features of the cardiac anatomy, specifically coronary artery anatomy...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29320927/benefits-of-using-high-volume-low-pressure-tracheal-tube-in-children-undergoing-congenital-cardiac-surgery-evidence-from-a-prospective-randomized-study
#12
Rakesh Chand, Saibal Roy Chowdhury, Emmanuel Rupert, Chandan Kumar Mandal, Pradeep Narayan
BACKGROUND: In the past 2 decades, usage of high-volume-low-pressure microcuffed tracheal tubes in smaller children has increased. However, there is paucity of evidence of its usage in smaller children undergoing congenital cardiac surgery. The aim of this study was to assess if microcuff endotracheal tubes in neonates and younger children undergoing congenital cardiac surgery is associated with better outcomes than uncuffed tubes. METHODS: We carried out this single-center, prospective, randomized study between June and November 2016...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29284365/echocardiographic-guidance-for-surgical-excision-of-the-intracardiac-component-of-a-pheochromocytoma
#13
Dinesh J Kurian, Angela X Li, Srikar Rao, Agathoklis Konstantinidis, Sanziana A Roman, Miklos D Kertai
Pheochromocytomas are rare neuroendocrine tumors, with published incidence of 2 to 8 cases per million patients per year. The extension of these tumors into the vena cava and right atrium is rarely seen. Transesophageal echocardiography may be invaluable to delineate tumor extent and characteristics, which in turn may provide a useful tool to guide intraoperative surgical approach to these uncommon masses. In the case presented in this article, we describe the role of transesophageal echocardiography in guiding a safe and complete, excision of an invasive pheochromocytoma without embolization of tumor components...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29277148/prostacyclins-in-cardiac-surgery-coming-of-age
#14
Seema P Deshpande, Michael A Mazzeffi, Erik Strauss, Allison Hollis, Kenichi A Tanaka
Prostacyclin (prostaglandin I2 [PGI2 ]) is an eicosanoid lipid mediator produced by the endothelial cells. It plays pivotal roles in vascular homeostasis by virtue of its potent vasodilatory and antithrombotic effects. Stable pharmacological analogues of PGI2 are used for treatment of pulmonary hypertension and right ventricular failure. PGI2 dose dependently inhibits platelet activation induced by adenosine-5'-diphosphate, arachidonic acid, collagen, and low-dose thrombin. This property has led to its use as an alternative to direct thrombin inhibitors in patients with type II heparin-induced thrombocytopenia (HIT) undergoing cardiac surgery...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29144180/intraoperative-hemodynamic-instability-and-diagnosis-of-pheochromocytoma-during-excision-of-adrenal-incidentaloma-with-incomplete-workup-a-case-report
#15
Anthony Chang, George Silvay, Andrew Goldberg
Preoperative evaluation of incidentalomas for pheochromocytoma is imperative. This case report describes a scheduled adrenalectomy in an asymptomatic patient with what was eventually determined to be an incomplete biochemical workup. The intraoperative course was complicated by labile and rapid increases in blood pressure and heart rate, suggesting the missed diagnosis of pheochromocytoma. It is important for anesthesiologists to ensure adequate preoperative biochemical workup before excluding the possibility of coexisting pheochromocytoma...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29047321/perioperative-and-anesthetic-considerations-in-pulmonary-atresia-with-intact-ventricular-septum
#16
Stephen Gleich, Gregory J Latham, Denise Joffe, Faith J Ross
Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare right-heart obstructive lesion with a wide anatomic and physiologic spectrum of disease, ranging from simple membranous pulmonary valve atresia with a fully developed right ventricle (RV) to a severely hypoplastic RV and ventriculocoronary (RV-coronary) fistulas. Affected neonates are dependent on prostaglandin for adequate pulmonary blood flow. Depending on the severity of disease, treatment options range from transcatheter pulmonary valve perforation and ultimate biventricular repair to staged single-ventricle palliation...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28992750/acute-hypotension-after-mitraclip-implantation-due-to-acute-left-ventricular-failure
#17
Adam A Dalia, Michael Essandoh
The MitraClip is a percutaneously implanted device approved for the treatment of symptomatic organic mitral regurgitation in poor surgical candidates. Despite its proven efficacy and safety for mitral regurgitation treatment, the MitraClip may unmask the true afterload of the left ventricle by removing the low-pressure left atrial system and may cause acute left ventricular systolic failure (afterload mismatch). Rapid diagnosis and treatment of afterload mismatch is crucial to ensure optimal patient outcomes...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30099939/current-approaches-to-ischemic-mitral-regurgitation-repair-replacement-or-nothing
#18
Daisuke Francis Nonaka, Amanda Arlene Fox
The treatment strategy for ischemic mitral regurgitation (MR) continues to evolve with the completion of multicenter trials and the advancement of surgical and percutaneous interventional techniques. This review defines ischemic MR, outlines key clinical trials that assess surgical and interventional approaches, and reports the main elements of recent national guidelines for decision making in treatment of ischemic MR. New findings in percutaneous mitral valve repair and replacement for ischemic MR will also be described...
August 13, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30095030/management-and-anesthetic-considerations-for-patients-with-anomalous-aortic-origin-of-a-coronary-artery
#19
Benjamin Kloesel, Martina Richtsfeld, Mojca Konia, John L Bass
The term "coronary artery anomalies" encompasses a large and heterogeneous group of disorders that may affect origin, intrinsic anatomy, course, location, and termination of the coronary arteries. With these different anatomies, presentation, symptoms, and outcomes are heterogeneous as well. While significant efforts are directed toward improving diagnosis and risk-stratification, best evidence-guided practices remain in evolution. Data about anesthetic management of patients with coronary anomalies are lacking as well...
August 10, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/30058475/combined-use-of-a-fiberscope-and-fuji-uniblocker-for-removal-of-retained-bronchial-tissue-glue-after-repair-of-a-disrupted-left-main-bronchus
#20
Alaa Mohamed Khidr, Mohamed R El Tahan, D John Doyle, Yasser Maher Aljehani
We describe the novel combined use of a fiberoptic bronchoscope and a Fuji Uniblocker placed outside the endotracheal tube (ETT) for removal of a retained BioGlue polymerized tissue fragment (2.8 × 0.8 cm) from the right main bronchus (RMB). The patient was a trauma victim who presented with a diffuse axonal injury, cervical spine and maxillofacial injuries, and a flail chest, and the procedure we describe took place following the surgical repair of a disrupted left main bronchus. Endoscopic retrieval using different sizes of grasping forceps and a Dormia basket failed to remove the foreign body (FB)...
July 30, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
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