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Seminars in Cardiothoracic and Vascular Anesthesia

Megan D Henley, Priya A Kumar
Tracheal laceration during cardiac surgery is a rarely reported form of iatrogenic tracheal injury. During dissection prior to sternotomy, the interclavicular ligament must be divided. This structure overlies the proximal trachea, predisposing the trachea to injury at this location. Challenges related to tracheal laceration in cardiac surgery include patients with already tenuous cardiopulmonary status, surgical positioning that increases the risk of injury, obscured traditional clinical findings causing delayed recognition, increased risk of mediastinitis, and a heightened risk of airway fire...
February 1, 2019: Seminars in Cardiothoracic and Vascular Anesthesia
Pedro Videira Reis, Ana Isabel Lopes, Diana Leite, João Moreira, Leonor Mendes, Sofia Ferraz, Tânia Amaral, Joana Mourão, Fernando Abelha
INTRODUCTION: Patients proposed to vascular noncardiac surgery (VS) have several comorbidities associated with major adverse cardiac events (MACE). We evaluated incidence, predictors, and outcomes, and compared different scores to predict MACE after VS. METHODS: We included all patients admitted from 2006 to 2013. Perioperative MACE included cardiac arrhythmias, myocardial infarction (MI), cardiogenic pulmonary edema (CPE), acute heart failure (AHF), and cardiac arrest (CA)...
January 25, 2019: Seminars in Cardiothoracic and Vascular Anesthesia
Eric B Fox, Gregory J Latham, Faith J Ross, Denise Joffe
Isolated coarctation of the aorta is a relatively common form of congenital heart disease that is characterized by variable degrees of obstruction to aortic outflow. The clinical presentation varies from asymptomatic arterial hypertension to cardiogenic shock. The treatment options include surgical repair or interventional therapy with aortic balloon dilation and stent placement. This article will summarize the pathophysiology as well as describe the surgical and interventional procedures. The anesthetic management for those interventions will be reviewed...
January 7, 2019: Seminars in Cardiothoracic and Vascular Anesthesia
Frederick W Lombard, Yafen Liang
No abstract text is available yet for this article.
January 4, 2019: Seminars in Cardiothoracic and Vascular Anesthesia
Sathish Chikkabyrappa, Guruprasad Mahadevaiah, Sujatha Buddhe, Tarek Alsaied, Justin Tretter
Common arterial trunk (CAT), or truncus arteriosus, is a rare form of cyanotic congenital heart disease and is highly associated with DiGeorge syndrome (microdeletion 22q11.2). Prenatal diagnosis is highly feasible, allowing proper delivery planning and postnatal management. The clinical presentation is highly variable depending on the anatomical variation; however, most commonly presenting with mild cyanosis and significant tachypnea, although these patients can often go undetected in the immediate newborn period...
December 29, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Olga L Quintero, Juan C Giraldo, Néstor F Sandoval
Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team...
December 27, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Mohammed Alreshidan, Robert D Herron, Lawrence M Wei, Chris C Cook, Muhammad Salman, Harold G Roberts, Vinay Badhwar
Mitral valve surgery has evolved over 4 decades from one based on the principles of prosthetic replacement to a subspecialty with a foundation based on the principles of repair. This review will attempt to enumerate the contemporary techniques of mitral valve repair and a pathoanatomically directed approach with which to apply them by focusing on degenerative disease and associated complexities.
December 5, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
J Mauricio Del Rio, Nathaen Weitzel, Miklos D Kertai
No abstract text is available yet for this article.
December 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Charles B Nyman, Douglas C Shook, Stanton Shernan
The advent of percutaneous therapies has significantly altered therapeutic options for patients with valvular heart disease. Building on the success of transcatheter aortic valve replacement, both expanded indications and purpose-built devices are now being used to address percutaneous approaches for mitral valve pathology. While surgical mitral valve repair remains the gold standard for addressing significant mitral valve pathology, there has been a progressive increase in the utilization of bioprosthetic valves despite their limited lifespan...
November 8, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Sharon L McCartney, Bradley S Taylor, Alina Nicoara
Functional tricuspid regurgitation is a common finding in patients with left-sided heart disease. If left untreated, it may reduce survival, limit functional capacity and cause end-organ dysfunction. Annulus dilation and leaflet tethering due to right ventricle remodeling are 2 major pathophysiologic mechanisms in functional tricuspid regurgitation. Even if surgical treatment remains the gold standard, indication and timing of surgical interventions remain the object of debate in the medical community. More recently, numerous transcatheter therapies have been developed in order to offer less invasive options to patients who otherwise would have a high risk of mortality and morbidity with surgical interventions...
November 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Malak Maharramova, Katherine Taylor
OBJECTIVES: In pediatric cardiac surgery, does caudal anesthesia promote early extubation, reduce pain scores, reduce stress responses, and length of stay (LOS)? DESIGN: A systematic review. PARTICIPANTS: Inclusion criteria included cardiac surgical procedures (with or without cardiopulmonary bypass) in any subject between the ages of full-term newborn and 18 years receiving caudal anesthesia of any medication combination. Searches were conducted with assistance of an Academic librarian from 1947 to July 2017...
September 28, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
J Mauricio Del Rio, Loreta Grecu, Alina Nicoara
Right ventricular (RV) function is an independent prognostic factor for short- and long-term outcomes in cardiac surgical patients. Patients with mitral valve (MV) disease are at increased risk of RV dysfunction before and after MV operations. Yet RV function is not part of criteria for decision making or risk stratification in this setting. The role of MV disease in the development of pulmonary hypertension (PHTN) and the ultimate impact of PHTN on RV function have been well described. Nonetheless, there are other mechanisms by which MV disease and MV surgery affect RV performance...
September 19, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Mark D Twite, Miklos D Kertai, Nathaen Weitzel
No abstract text is available yet for this article.
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Rishi Parikh, Michael Eisses, Gregory J Latham, Denise C Joffe, Faith J Ross
Truncus arteriosus is a congenital cardiac lesion in which failure of embryonic truncal septation results in a single semilunar valve and single arterial trunk providing both pulmonary and systemic circulations. Most patients with this lesion are symptomatic in the neonatal period with cyanosis and/or congestive heart failure and undergo complete repair in the first weeks of life. This review will focus on the anatomy, physiology, and perioperative anesthetic management of patients with truncus arteriosus.
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Damien J LaPar, Christopher W Baird
Interrupted aortic arch (IAA) is a rare congenital anomaly with several anatomical variants and is often associated with other intracardiac and/or extracardiac congenital anomalies. Historically, associated with high early mortality, outcomes for this anomaly have improved in recent eras with advances in perioperative and anesthesia management and refinements in surgical technique. This review provides a description of surgical anatomy, anatomical classifications, and associated congenital lesions as well as an examination of the perioperative and surgical management of IAA in the contemporary surgical era...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Nelson Burbano-Vera, Katherine L Zaleski, Gregory J Latham, Viviane G Nasr
Interrupted aortic arch (IAA) is defined as the loss of luminal continuity between the ascending and descending aorta and is classified based on the anatomic level of interruption. IAA is associated with a number of intracardiac anomalies with the most common being patent ductus arteriosus, ventricular septal defect, and left ventricular outflow obstruction. There is also a strong association between type B interruption and 22q11 deletion syndrome. The perioperative management of the neonate with IAA begins in the intensive care unit with optimization of end-organ perfusion and function...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Andrew J Matisoff, Pranathi Ari, David Zurakowski, Alexandra G Espinel, Nina Deutsch, Brian K Reilly
OBJECTIVE: In this single-center, retrospective review, we sought to determine the risk factors associated with the development of severe acquired airway disease (AAD; vocal cord paralysis [VCP] or subglottic stenosis [SGS]) in pediatric patients who had undergone surgery for congenital heart disease (CHD) with cardiopulmonary bypass. All patients who required surgical treatment for CHD using cardiopulmonary bypass at our institution between 2010 and 2015 were reviewed. We defined severe AAD as either clinically significant VCP, SGS, or both, requiring consultation with the otolaryngology (ENT) service for evaluation...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Kevin Friedman
Interrupted aortic arch (IAA) is a rare form of critical neonatal heart disease in which there is lack of continuity between the ascending aorta and the descending thoracic aorta. In the absence of prenatal diagnosis, patients with IAA present in shock when the patent ductus arteriosus closes. Diagnosis can generally be made by echocardiography, and initiation of prostaglandin E1 infusion allows for adequate lower body perfusion prior to surgical repair. Full neonatal repair can be achieved with good outcomes in most cases...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Sathish M Chikkabyrappa, Rohit S Loomba, Justin T Tretter
Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare complex cyanotic congenital heart disease with heterogeneous morphological variation. Prenatal diagnosis allows for developing a safe plan for delivery and postnatal management. While transthoracic echocardiography allows for detailed delineation of the cardiac anatomy, additional imaging modalities such as computed tomography, magnetic resonance imaging, and catheterization may be necessary to further outline features of the cardiac anatomy, specifically coronary artery anatomy...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Rakesh Chand, Saibal Roy Chowdhury, Emmanuel Rupert, Chandan Kumar Mandal, Pradeep Narayan
BACKGROUND: In the past 2 decades, usage of high-volume-low-pressure microcuffed tracheal tubes in smaller children has increased. However, there is paucity of evidence of its usage in smaller children undergoing congenital cardiac surgery. The aim of this study was to assess if microcuff endotracheal tubes in neonates and younger children undergoing congenital cardiac surgery is associated with better outcomes than uncuffed tubes. METHODS: We carried out this single-center, prospective, randomized study between June and November 2016...
September 2018: Seminars in Cardiothoracic and Vascular Anesthesia
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