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Seminars in Cardiothoracic and Vascular Anesthesia

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https://www.readbyqxmd.com/read/27913770/cor-triatriatum-a-review
#1
REVIEW
Ajay Kumar Jha, Neeti Makhija
Cor triatriatum is a rare congenital cardiac anomaly defined by an abnormal septation within the atrium (left or right) leading to inflow obstruction to the respective ventricles. It exists either in isolated classical form or may be associated with simple to complex congenital cardiac anomalies. Several anatomical variants exist even in the classical form, and therefore, it may require multimodal diagnostic modalities to characterize and differentiate for better percutaneous interventional or surgical planning...
December 2, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27837084/intraoperative-diagnosis-of-intracardiac-thrombus-during-orthotopic-liver-transplantation-with-transesophageal-echocardiography-a-case-series-and-literature-review
#2
Adam A Dalia, Hisham Khan, Antolin S Flores
Anesthesia for orthotopic liver transplantation (OLT) is challenging for any anesthesiologist as the patients undergoing this procedure are among the most critically ill. Adding to the underlying complexity of OLT management is the rare complication of an intracardiac thrombus (ICT). Intracardiac thrombi can present following liver allograft reperfusion resulting in high morbidity and mortality. Currently there is no consensus treatment for ICT, and the gold standard for diagnosis is intraoperative transesophageal echocardiography (TEE); these 2 factors lead to a dangerous amalgam of the difficulty in diagnosing and treating the disease...
November 10, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27831520/total-anomalous-pulmonary-venous-connection-preoperative-anatomy-physiology-imaging-and-interventional-management-of-postoperative-pulmonary-venous-obstruction
#3
REVIEW
Matthew D Files, Brian Morray
Total anomalous pulmonary venous connection refers to a spectrum of cardiac anomalies where the pulmonary veins fail to return to the left atrium and the pulmonary venous blood returns through a systemic vein or directly to the right atrium. There is a wide anatomical variety of venous connections and degrees of pulmonary venous obstruction that affect the presentation, surgical repair, and outcomes. In this review, we explore the preoperative physiology, echocardiographic diagnosis, and approach to postoperative complications...
November 9, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27815350/the-anesthetic-challenges-of-lung-biopsy-associated-intrathoracic-hemorrhage-in-a-child-with-suprasystemic-pulmonary-hypertension
#4
Rachel Gabrielle Clopton, Robert Friesen, David Partrick, Neil Wilson, James Jaggers, David Dunbar Ivy, Lawrence Israel Schwartz, Richard John Ing
Children with suspected pulmonary hypertension must undergo extensive and invasive evaluations to establish a definitive diagnosis. A previously healthy 4-year old girl, newly diagnosed with suprasystemic pulmonary hypertension required multiple lung biopsies. Each procedure was associated with significant bleeding. The challenging anesthetic management of lung biopsy in the presence of suprasystemic pulmonary hypertension is described.
November 3, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27765875/hemiarch-the-real-operation-for-ascending-aortic-aneurysm
#5
Ramesh Singh, Katsuhiro Yamanaka, T Brett Reece
The extent and technique of resection for ascending aortopathies remains debated. The 2 main camps are divided into those who believe in the hemiarch resection utilizing hypothermic circulatory arrest and those who feel that the same goal can be accomplished with just an ascending aortic resection with an aortic cross clamp. While this debate continues to happen within groups and in some cases even in the same hospital, it certainly has not happened in the literature. There are no studies directly comparing the safety and efficacy of these 2 ideologies...
October 19, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27742818/a-clinical-protocol-for-goal-directed-cerebral-perfusion-during-aortic-arch-surgery
#6
Matthew S Mosca, George Justison, T Brett Reece
OBJECTIVE: The optimal strategy to deliver antegrade cerebral perfusion for cerebral protection during hypothermic circulatory arrest has not been established. The purpose of this review was to present our current clinical protocol utilizing selective antegrade cerebral perfusion during aortic arch surgery and to compare it to other published experience. CLINICAL PROTOCOL: Since 2013, our clinical protocol for aortic arch surgery has evolved to using selective antegrade cerebral perfusion via the innominate artery, moderate hypothermia, and ancillary strategies such as goal-directed perfusion (GDP)...
October 14, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27694572/perioperative-and-anesthetic-considerations-in-total-anomalous-pulmonary-venous-connection
#7
Faith J Ross, Denise Joffe, Gregory J Latham
Total anomalous pulmonary venous connection (TAPVC) is a potentially devastating form of congenital heart disease in which all pulmonary blood flow returns to the systemic venous circulation rather than the left atrium. Anomalous pulmonary venous flow may be obstructed at birth, and affected infants present with severe cyanosis and poor cardiac output unresponsive to standard resuscitation with prostaglandin. Obstructed TAPVC remains one of the few indications for emergent neonatal cardiac surgery. This review will discuss the physiology and perioperative management of isolated TAPVC without associated cardiac lesions...
September 29, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27821788/cardiac-calendar-2016-2020
#8
(no author information available yet)
No abstract text is available yet for this article.
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27821787/arterial-cannulation-and-cerebral-perfusion-strategies-for-aortic-arch-operations
#9
REVIEW
Lisa S Foley, Katsuhiro Yamanaka, T Brett Reece
Neurologic injuries following aortic arch operations can be devastating, with stroke occurring in up to 12% of elective operations and significant cerebral dysfunction occurring in up to 25% of cases. The primary challenge unique to aortic arch operations involves interruption of direct perfusion of the brachiocephalic vessels during arch reconstruction. For this reason, neuroprotection is paramount. The 2 main modes of protection are (1) reducing metabolic demand through hypothermia and (2) limiting, or even eliminating, the ischemic period...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27821786/temperature-management-for-aortic-arch-surgery
#10
REVIEW
Edward P Chen, Bradley Graham Leshnower
Surgical treatment of aortic arch disease is a technically challenging procedure that requires complex circulation management strategies involving the use of hypothermic circulatory arrest. The definition of hypothermia has evolved with comfort and surgical adjuncts. This review describes the various circulation and temperature management strategies used during hemiarch and total arch replacement.
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27821785/anesthetic-considerations-for-surgery-on-the-aortic-arch
#11
REVIEW
Barbara J Wilkey, Nathaen S Weitzel
Aortic arch surgery requires meticulous teamwork in the true perioperative sense. Planning and communication at all phases from preoperative evaluation, through intraoperative management, to postoperative care should be well coordinated between surgical, anesthesia, perfusion, and intensive care unit teams. This review discusses intraoperative management from the anesthesiologist's perspective, with particular emphasis on transesophageal echo evaluation and coagulation management.
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27821784/perioperative-management-for-complex-aortic-arch-disease
#12
EDITORIAL
T Brett Reece, Nathaen S Weitzel
No abstract text is available yet for this article.
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27765887/total-aortic-arch-replacement-advantages-of-varied-techniques
#13
REVIEW
Ryan C Shelstad, Justin G Reeves, Katsuhiro Yamanaka, T Brett Reece
We review the operative techniques of aortic arch replacement. Aortic arch replacement presents several formidable challenges, as it requires arresting the circulation to the body and replacement of the brachiocephalic vessels with special consideration for protecting the central nervous system. Perfusion strategies, selective antegrade cerebral perfusion, and operative graft selection are key elements in aortic arch replacement surgery. Standard approaches include the island technique, the branched graft technique, and the "Spielvogel" trifurcated graft technique-each having its own advantages...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27708177/neurophysiological-intraoperative-monitoring-during-aortic-arch-surgery
#14
REVIEW
Jeffrey E Keenan, Ehsan Benrashid, Emily Kale, Alina Nicoara, Aatif M Husain, G Chad Hughes
Circulatory management during replacement of the aortic arch is complex and involves a period of circulatory arrest to provide a bloodless field during arch vessel anastomosis. To guard against ischemic brain injury, tissue metabolic demand is reduced by systemically cooling the patient prior to circulatory arrest. Neurophysiological intraoperative monitoring (NIOM) is often used during the course of these procedures to provide contemporaneous assessment of brain status to help direct circulatory management decisions and detect brain ischemia...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27496825/immediate-icu-care-for-patients-following-aortic-arch-surgery
#15
Maung Hlaing
Patients undergoing aortic arch surgery are at high risk for stroke, delirium, low cardiac output, respiratory failure, renal failure, and coagulopathy. A significantly higher mortality is seen in patients experiencing any of these complications when compared with those without complications. As surgical, perfusion, and anesthetic techniques improve, the incidence of major complications have decreased. A recent paradigm shift in cardiac surgery has focused on rapid postoperative recovery, and a similar change has affected the care of patients after arch surgery...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27418027/hybrid-techniques-for-aortic-arch-aneurysm-repair
#16
REVIEW
Ibrahim Sultan, Joseph E Bavaria, Wilson Szeto
Open repair of the aortic arch remains the gold standard for aortic aneurysms and dissections. However, in elderly patients with comorbidities, and in patients where prolonged cardiopulmonary bypass time and circulatory arrest may pose a significant risk, hybrid techniques in repairing the aortic arch have become quite attractive. Hybrid arch surgery includes a combination of endovascular and open surgery that allows surgeons to operate on the arch in a safe and expeditious manner with potential decrease in morbidity and mortality...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27418026/aortic-arch-replacement-in-patients-with-chronic-dissection-special-considerations
#17
REVIEW
Kim I de la Cruz, Susan Y Green, Ourania A Preventza, Joseph S Coselli
The progressive expansion of residual, chronic DeBakey type I dissection often necessitates repair of the aortic arch and the distal aorta (ie, descending thoracic and thoracoabdominal aorta). The vast majority of patients with chronic aortic dissection facing aortic arch surgery are survivors of emergent proximal aortic repair for acute dissection, and thus, these patients now face a reoperative procedure necessitating a redo median sternotomy. One approach for repairing the chronic type I aortic dissection incorporates total transverse aortic arch replacement with and without an elephant trunk extension; an elephant trunk extension is a useful strategy, because the proximal descending thoracic aorta is commonly ectatic or aneurysmal at the time of aortic arch repair-using an elephant trunk approach facilitates subsequent repair in the distal aorta...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27436637/meet-the-demand-challenges-of-practicing-cardiac-anesthesiology
#18
EDITORIAL
Miklos D Kertai
No abstract text is available yet for this article.
September 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27317553/multiparameter-predictor-of-fluid-responsiveness-in-cardiac-surgical-patients-receiving-tidal-volumes-less-than-10-ml-kg
#19
Keita Ikeda, Gregory Smith, John Renehan, James Isbell, Timothy McMurry, Mitchell Rosner, Robert Thiele
Introduction We hypothesize that respiratory variation in the pulmonary artery tracing predicts fluid responsiveness (primary hypothesis) and that inclusion of multiple physiologic waveforms as well as ventilator settings in a predictive model of fluid responsiveness would lead to improvements in the clinical utility of this class of metrics (secondary hypothesis). Methods Blood pressure tracings were prospectively recorded in 35 patients immediately following cardiac surgery. Fluid bolus administration data, ventilator settings, and cardiac output were recorded prospectively before and after fluid boluses given at the discretion of the treating physician...
September 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27233818/prolonged-intraoperative-cardiac-resuscitation-complicated-by-intracardiac-thrombus-in-a-patient-undergoing-orthotopic-liver-transplantation
#20
Sang Kim, Samuel DeMaria, Edmond Cohen, George Silvay, Jeron Zerillo
We report the case of successful resuscitation after prolonged cardiac arrest during orthotopic liver transplantation. After reperfusion, the patient developed ventricular tachycardia, complicated by intracardiac clot formation and massive hemorrhage. Transesophageal echocardiography demonstrated stunned and nonfunctioning right and left ventricles, with developing intracardiac clots. Treatment with heparin, massive transfusion and prolonged cardiopulmonary resuscitation ensued for 51 minutes. Serial arterial blood gases demonstrated adequate oxygenation and ventilation during cardiopulmonary resuscitation...
September 2016: Seminars in Cardiothoracic and Vascular Anesthesia
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