Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
Case Reports4-Valve Heart Disease and Right Heart Failure.
Carcinoid heart disease is a rare form of heart disease due to secretion of vasoactive compounds, including serotonin, from gastrointestinal tumors. This E-challenge examines the case of a patient with advanced carcinoid heart disease who presented to the operating room (OR) for a tricuspid valve replacement. Once the patient was in the OR, intraoperative transesophageal echocardiography was used to discover a patent foramen ovale and involvement of all 4 valves with regurgitant lesions. ⋯ Identifying patients who are at high risk for intraoperative right heart failure and considering what constitutes an adequate preoperative assessment of right heart function aid in preparing for OR management. In addition, reviewing the potential options for managing these patients when the traditional therapies are inadequate, including mechanical support and extracorporeal circulation, is a useful exercise in preparation. This case also highlights the contributions of intraoperative transesophageal echocardiography in the diagnosis and management of carcinoid heart disease, the need for additional preoperative optimization of these patients, and the management and potential complications of mechanical support.
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
Observational StudyFeasibility and Impact of Focused Intraoperative Transthoracic Echocardiography on Management in Thoracic Surgery Patients: An Observational Study.
Intraoperative focused transthoracic echocardiography (TTE) is feasible and has an effect on the management of hemodynamically unstable surgical patients. Furthermore, in noncardiac thoracic surgery, TTE might provide additional information for hemodynamic treatment. Transthoracic accessibility during thoracic surgical interventions is assumed to be difficult. For patients positioned on their right side, a modified subcostal transthoracic view might be helpful. ⋯ TTE in noncardiac thoracic surgery is feasible using a modified subcostal view and has an effect on hemodynamic management in a considerable number of patients.
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
Association Between Optic Nerve Head Blood Flow Measured Using Laser Speckle Flowgraphy and Radial Arterial Pressure During Aortic Arch Surgery.
This study was designed to investigate the association between ocular blood flow measured using laser speckle flowgraphy (LSFG) and radial arterial pressure during aortic arch surgery. ⋯ Intraoperative monitoring of optic nerve head blood flow using LSFG can be used as an additional cerebral perfusion parameter during aortic arch surgery with CPB using antegrade SCP.
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
Observational StudyRisk Factors for Radial-to-Femoral Artery Pressure Gradient in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass.
To identify risk factors associated with radial-to-femoral pressure gradient during cardiac surgery with cardiopulmonary bypass (CPB). ⋯ A radial-to-femoral pressure gradient occurs in 34% of patients during cardiac surgery. Patients at risk seem to be of smaller stature, hypertensive, and undergo longer and more complex surgeries.
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J. Cardiothorac. Vasc. Anesth. · Apr 2018
Contemporary Single-Center Experience With Prophylactic Cerebrospinal Fluid Drainage for Thoracic Endovascular Aortic Repair in Patients at High Risk for Ischemic Spinal Cord Injury.
To review rates of permanent paraplegia and lumbar drain-related complications in patients undergoing thoracic endovascular aortic repair (TEVAR) surgery with prophylactic cerebrospinal fluid (CSF) drainage at the authors' institution. ⋯ Prophylactic CSF drainage was associated with low paraplegia and drain-related complication rates. These data further support the safety of prophylactic CSF drainage in patients undergoing TEVAR with a high risk for ischemic spinal cord injury.