Seminars in cardiothoracic and vascular anesthesia
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Semin Cardiothorac Vasc Anesth · Dec 2011
Case ReportsTransesophageal echocardiography-guided aortic thrombectomy in a patient with a mobile thoracic aortic thrombus.
Thoracic aortic thrombi are a well-known cause of distal embolic phenomena. There is a paucity of case reports because of the rarity of this condition, and thus clear management guidelines are lacking. ⋯ The utility of TEE in the diagnosis and management of aortic thrombi is also discussed. In addition, currently reported management strategies for this complex condition are reviewed.
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Semin Cardiothorac Vasc Anesth · Dec 2011
Case ReportsSevere pulmonary hypertension and right ventricular failure complicate a total abdominal hysterectomy.
The 2007 American College of Cardiology/American Heart Association guidelines report that no significant studies have been conducted assessing the perioperative risk of pulmonary hypertension in noncardiac surgery. However, the presence of right ventricular failure has been well documented to have poor prognostic implications. The presence of pulmonary hypertension and right ventricular failure present unique perioperative challenges. These include maintenance of adequate cardiac function, acid-base management, intraoperative monitoring, and postoperative pain management. ⋯ This case illustrates the unique challenges associated with pulmonary hypertension and right ventricular failure in the setting of noncardiac surgery. This case also demonstrates that continuous, real-time data provided by transesophageal echocardiography can be used to successfully manage a complicated patient with pulmonary hypertension.
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Semin Cardiothorac Vasc Anesth · Sep 2011
Review Case ReportsManagement of acquired cardiac disease in the obstetric patient.
Physiologic changes incurred by pregnancy can cause severe decompensation in the parturient with underlying cardiac disease. The result is increased morbidity and mortality for both mother and child. Appropriate anesthetic management can significantly impact these outcomes. This review systematically presents the pathophysiology, peripartum risk, and anesthetic management in the puerperium of specific acquired cardiac abnormalities including: valvular disease, pulmonary hypertension, cardiomyopathy, cardiac transplantation, ischemia, arrhythmias, and cardiac arrest.
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Semin Cardiothorac Vasc Anesth · Sep 2011
Cesarean delivery and colon resection in a patient with type III osteogenesis imperfecta.
OBJECTIVE. Osteogenesis imperfecta is a connective tissue disorder that results from the inability to produce normal collagen. Eight types are described; type II is considered the lethal variant. ⋯ CLINICAL CHALLENGES. (a) Preoperative assessment of an osteogenesis imperfecta patient, (b) determination of anesthetic type, (c) management of hemorrhage/cardiovascular instability, and (d) management of hyperthermia. CONCLUSIONS. This case report illustrates that, with proper knowledge of this disease state, osteogenesis imperfecta patients can undergo a safe anesthetic during a potentially challenging combined cesarean section/colonic resection.
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As ultrasound technology improves and ultrasound availability increases, echocardiography utilization is growing within intensive care units. Although not replacing the often-needed comprehensive echocardiographic evaluation, limited bedside echocardiography promises to provide intensivists with enhanced diagnostic ability and improved hemodynamic understanding of individual patients. Routine and emergency echocardiography within the intensive care unit focuses on identifying and optimizing medically treatable conditions in a timely manner. Methods for such goal-directed assessments are presented.