{"title":"Thoracic Aortic Aneurysm","authors":"A. Dahl, R. Fagley","doi":"10.1093/MED/9780190884512.003.0028","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0028","url":null,"abstract":"Thoracic and thoracoabdominal aortic aneurysms often require surgical repair depending on the size of the aneurysm and the acuity of progression. The involvement of the aortic arch makes consideration of surgical approaches challenging, as it contains the vessels that provide cerebral perfusion. Risk factors for growth and rupture of thoracoabdominal aneurysms include aneurysm size, rapid aneurysm growth, aortic dissection, older age, female sex, chronic obstructive pulmonary disease, cigarette smoking, pain, and a positive family history. Without surgical repair, there is a risk of fatal rupture. Planning the appropriate surgical approach is complex, and protection of the spinal cord from ischemic complications is of paramount importance.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125945452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Minimally Invasive Esophagectomy","authors":"Brandon Merling, F. Dupont","doi":"10.1093/MED/9780190884512.003.0031","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0031","url":null,"abstract":"Esophageal cancer is the eighth most common malignancy worldwide, producing a high morbidity and mortality rate around the globe. Minimally invasive esophagectomy (MIE) is most commonly performed on patients with this devastating disease. Esophagectomy is a high-risk procedure, and perioperative mortality remains around 5%–8%. Because esophageal cancer is associated with chronic alcohol and tobacco use, patients have serious comorbid conditions that affect anesthetic management and perioperative care. Among them, pulmonary complications and anastomotic failure remain the most common causes of perioperative morbidity and mortality. The anesthesiologist managing a patient during MIE must be able to reduce the effect of the patient’s multiple comorbidities intraoperatively while mitigating the factors that lead to adverse postoperative outcomes.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120976957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mitral Valve Surgery","authors":"S. Mahboobi","doi":"10.1093/MED/9780190884512.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780190884512.003.0004","url":null,"abstract":"The mitral valve consists of the mitral annulus, anterior and posterior mitral leaflets, anterolateral and posteromedial papillary muscles attached to mitral leaflets with chordae tendineae, and the left ventricle. Any condition or pathological process involving one or more of these components will affect proper functioning of the valve. A degenerative mitral valve disease process is commonly followed by functional mitral regurgitation. Rheumatic heart disease involving the mitral valve is not common in developed countries but is the most common cause of mitral disease in developing countries. A surgical procedure involving the mitral valve requires a thorough understanding of the physiology of a normally functioning valve as well as the mechanism of pathological processes affecting the valve. Mitral regurgitation is more common than mitral stenosis, and mitral valve repair is a preferable technique over replacement of the valve due to less chance of endocarditis, no thrombolytic therapy requirement, and maintenance of normal physiology of the valve. Anesthesiologists providing care for these patients in the operating room play a pivotal role in successful mitral valve procedures by determining the primary mechanism of the pathology, recommending if the valve is repairable, and evaluating the success of the surgical intervention.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126219919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiac Tumors","authors":"Katherine Kozarek, R. Hood","doi":"10.1093/med/9780190884512.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780190884512.003.0005","url":null,"abstract":"Cardiac tumors are rarely encountered in clinical practice; however, because they affect vital structures, they can have significant consequences. Cardiac tumors are categorized as either primary tumors originating from cardiac tissue or metastatic tumors migrated from other sites; they may infiltrate the atria, ventricles, valves, and coronary arteries, resulting in considerable changes to normal physiology. They may extend beyond the myocardium to the pericardium, great vessels, and mediastinum. Advances in the development of imaging modalities have allowed for expedited diagnostic evaluation of cardiac tumors. Prompt treatment, which often includes surgical intervention, is essential to both alleviate symptoms and prevent harmful sequelae. The intraoperative anesthetic management of a patient with a cardiac mass presents a number of challenges due to altered cardiovascular physiology. Because these tumors occur so infrequently, standardized, evidence-based diagnostic and treatment guidelines have not been developed. The existing data were derived mainly from small case series and case reports. The aggressive nature of the disease warrants further investigation to improve the accuracy of diagnostic modalities and the efficacy of treatment regimens.","PeriodicalId":103017,"journal":{"name":"Cardiac Anesthesia: A Problem-Based Learning Approach","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126962874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}