Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Epiaortic Ultrasound for Assessment of Intraluminal Atheroma; Insights from the REGROUP Trial.
To assess the use of epiaortic ultrasound in contemporary cardiac surgery, as well as its impact on surgical cannulation strategy and cerebrovascular events. ⋯ Despite current guidelines recommending routine use of epiaortic ultrasound (IIa/B) to reduce the risk of stroke in cardiac surgery, in this contemporary trial, use remains infrequent, with significant site-to-site variability.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Echocardiography-Guided Dual-Lumen Venovenous Extracorporeal Membrane Oxygenation Cannula Placement in the ICU-A Retrospective Review.
The most effective method of image guidance for venovenous extracorporeal membrane oxygenation is not known. The authors' objectives were to define the frequency of successful initial cannulation using echocardiographic guidance in the intensive care unit, as well as to determine the frequency of subsequent adjustments. Additional aims were to illustrate cannula malposition problems and to describe features associated with difficult cannulation. ⋯ Dual-lumen venovenous extracorporeal membrane oxygenation cannulation in the intensive care unit under echo guidance has a high initial success rate, but many patients require subsequent repositioning. Echocardiography can define cannula position in sufficient detail to identify malposition precisely and to guide repositioning.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Insurance Status and Socioeconomic Markers Affect Readmission Rates After Cardiac Valve Surgery.
To characterize the effect of insurance status and other socioeconomic markers on readmission rates after cardiac valve surgery. ⋯ Markers of low socioeconomic status, including insurance status, race, and household income, are associated with an increased odds of readmission after cardiac valve surgery. Such findings may point to inequalities in health care; additional investigation is necessary to understand the causal link.
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J. Cardiothorac. Vasc. Anesth. · Mar 2020
Case ReportsPulmonary Artery Stenosis in a Patient with Prior Histoplasmosis and the Discovery of Complications.
Pulmonary hypertension (PH) results from varied etiologies, leading to progressive symptoms and limiting physical activity and quality of life, with associated morbidity and mortality. External compression of the pulmonary artery (PA) is a rare cause of PH and may give the clinician cause to investigate compression of nearby structures. In this E-Challenge, the authors present a case of PA stenosis in a patient with prior histoplasmosis scheduled for left PA stenting. ⋯ TEE revealed external compression of the pulmonary veins. This case highlights the value of pathophysiologic understanding, preoperative planning, and the effect of echocardiography on clinical management and patient safety. In this case, TEE prevented possible morbidity and mortality.