Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · May 2020
ReviewPerioperative Echocardiography in the Adult With Congenital Heart Disease.
Survival of patients with congenital heart disease has significantly improved over the last 2 decades, confronting interventionalists, surgeons, anesthesiologists, cardiologists, and intensivists with often unfamiliar complex pathophysiology in the perioperative setting. Aside from cardiac catheterization, echocardiography has become the main imaging modality in the hospitalized adult with congenital heart disease. The great variety of congenital lesions and their prior surgical management challenges practitioners to generate optimal imaging, reporting, and interpretation of these complex anatomic structures. ⋯ In this publication, the authors review current international consensus recommendations on echocardiographic imaging of adults with congenital heart disease and describe the fundamental components by specific lesion. The authors will emphasize key aspects pertinent to the clinical management when imaging these patients in the perioperative setting. The goal of this review is to familiarize the perioperative physician on how to structure and standardize echocardiographic image acquisition of congenital heart disease anatomy for optimal clinical management.
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J. Cardiothorac. Vasc. Anesth. · May 2020
Multicenter StudyExtracorporeal Cardiopulmonary Resuscitation: Outcomes and Complications at a Quaternary Referral Center.
At a quaternary care center that regularly performs and cares for patients undergoing extracorporeal cardiopulmonary resuscitation (eCPR), a database of all adult patients who underwent eCPR with venoarterial extracorporeal membrane oxygenation (ECMO) over a 10-year period was reviewed. Seventy-one eCPR patients were analyzed to compare outcomes and complication rates. The authors hypothesized that evidence of end-organ injury, such as the need for continuous renal replacement therapy, in their institution's eCPR population would be associated with increased in-hospital mortality. ⋯ In this cohort of 71 patients who underwent eCPR, outcomes were promising; however, complication rates were high, and renal failure in particular demonstrated an extremely high mortality. These are single-institution results that should be followed up with larger multicenter cohorts of eCPR patients.
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J. Cardiothorac. Vasc. Anesth. · May 2020
The Effect of Common Interventions in the Intensive Care Unit on Right Ventricular Function After Cardiac Surgery-An Intervention Study.
Critical care therapy after cardiac surgery includes interventions to aid pulmonary and cardiac function. The aim of this study was to investigate the effect of such interventions on right ventricular function (RVF). ⋯ In patients with normal RVF undergoing CABG, several routine interventions in the ICU affect RVF, in particular PEEP and VVI pacing, which induces clinically important reductions in stroke volume.
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J. Cardiothorac. Vasc. Anesth. · May 2020
Case ReportsA Rapid Development of a Right Ventricular Aneurysm Postmyocardial Infarction.
Myocardial infarctions may cause ventricular aneurysms. Ischemia-induced ventricular changes are more common in the left ventricle owing to the larger vascular supply, greater volume of myocardium, and increased intra-ventricular pressure. ⋯ The authors describe the echocardiographic progression of a right ventricular ischemic aneurysm resulting from an ST-elevated myocardial infarction in a 71- year-old man. In this E-Challenge, the authors will review the echocardiographic findings and pathophysiology of ischemic aneurysms.