Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Editorial Observational StudyImproving the Reporting of Observational Trials.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Case ReportsIntraoperative Diagnosis of a Stuck Bioprosthetic Valve Leaflet Due to a Loop of Suture After Mitral Valve Replacement.
A stuck mechanical valve leaflet is a well-known cardiovascular complication; however, a stuck bioprosthetic valve is a rare but potentially fatal complication. Herein a case of stuck bioprosthetic mitral valve caused by a loop of suture, which was detected on intraoperative 3-dimensional (3D) transesophageal echocardiography immediately after cardiopulmonary bypass, is presented. Restricted motion of the 2 leaflets during diastole and incomplete coaptation during systole were observed clearly on 3D imaging. Thus, intraoperative 3D transesophageal echocardiography imaging is useful for detecting such complications immediately after cardiopulmonary bypass.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
ReviewMitral Regurgitation in 2020: The 2020 Focused Update of the 2017 American College of Cardiology Expert Consensus Decision Pathway on the Management of Mitral Regurgitation.
The recently published "2020 Focused Update of the 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation" provides a framework for the clinical and echocardiographic assessment of mitral regurgitation and describes considerations for the medical, surgical, and transcatheter treatment of mitral regurgitation. The Update provides guidance for clinicians in light of the significant interim developments since the 2017 recommendations, particularly in the areas of secondary mitral regurgitation and transcatheter mitral valve repair. The present review focuses on the aspects of the Update that are most relevant to the cardiac anesthesiologist, with emphasis on the integrated assessment of mitral regurgitation with echocardiography and the indications and considerations for the surgical and transcatheter management of mitral regurgitation.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
ReviewHeart Failure With Preserved Ejection Fraction: A Comprehensive Review and Update of Diagnosis, Pathophysiology, Treatment, and Perioperative Implications.
Almost three-quarters of all heart failure patients who are older than 65 have heart failure with preserved ejection fraction (HFpEF). The proportion and hospitalization rate of patients with HFpEF are increasing steadily relative to patients in whom heart failure occurs as result of reduced ejection fraction. The predominance of the HFpEF phenotype most likely is explained by the prevalence of medical conditions associated with an aging population. ⋯ With the exception of symptom mitigation, lifestyle modifications, and rigorous control of comorbid conditions, few long-term treatment options exist for these unfortunate individuals. Patients with HFpEF present for surgery on a regular basis, and anesthesiologists need to be familiar with this heterogeneous and complex clinical syndrome to provide successful care. In this article, the authors review the diagnosis, pathophysiology, and treatment of HFpEF and also discuss its perioperative implications.
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J. Cardiothorac. Vasc. Anesth. · Jun 2021
Observational StudyRight Ventricular Longitudinal Strain Predicts Low-Cardiac- Output Syndrome After Surgical Aortic Valve Replacement in Patients With Preserved and Mid-range Ejection Fraction.
The aim of this study was to analyze whether right ventricular free wall longitudinal strain (RVFWSL) could be a predictor of low-cardiac-output syndrome (LCOS) after surgical aortic valve replacement (SAVR) in patients with left ventricular ejection fraction ≥40%. ⋯ RVFWSL seems to be a predictor of LCOS in patients with severe aortic stenosis and LVEF ≥40% undergoing SAVR. RVFWSL less than -17.3% may identify patients at increased risk for LCOS.