Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
Review Case ReportsLeft ventricular assist device outflow cannula obstruction by the rare environmental fungus Myceliophthora thermophila.
Left ventricular assist devices are used to provide mechanical circulatory support during end-stage heart failure either as a destination therapy or as a bridge to heart transplantation. Perioperative transesophageal echocardiography is becoming an invaluable tool to investigate device function during implantation and in case of mechanical malfunction. ⋯ Here, we present a case of severe outflow conduit obstruction by a rare environmental fungus, Myceliophthora thermophila. After replacement of the infected device and intensive antifungal treatment, heart transplantation was performed 2 yr later.
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Anesthesia and analgesia · Jan 2009
ReviewIntraoperative Doppler tissue imaging is a valuable addition to cardiac anesthesiologists' armamentarium: a core review.
Endocardial motion and surface/volume changes during the cardiac cycle are echocardiographic methods for regional (analysis of wall motion) and global (fractional area change, stroke volume, and ejection fraction) evaluation of cardiac function. These conventional methods can be subjective, and/or time consuming and, depending upon circumstances, may divert the anesthesiologist's attention from intraoperative activities. Doppler tissue imaging (DTI) is a novel echocardiographic technique, which displays and measures systolic and diastolic velocity from a myocardial region. ⋯ The numeric information (velocity or time intervals) is easily obtained and measured. Assessment of systolic and diastolic function on regional (detection of ischemia) as well as global level (ejection fraction, grading of diastolic dysfunction) and evaluation of filling pressure can be derived from DTI signals and used by any practicing cardiac anesthesiologist. This review describes the principles, imaging modalities, and clinical applications of DTI.