Seminars in Cardiothoracic and Vascular Anesthesia最新文献

{"title":"Estimation of Systolic and Diastolic Left Ventricular Blood Flow From Derivatives of Transesophageal Echocardiographic 3D Volume Curves in Cardiac Surgery Patients: A Proof-of-Concept Study.","authors":"Paul-Michael Jokiel, Thilo Schweizer, Dominik P Guensch, Denis Berdajs, Joachim Erb, Daniel Bolliger, Firmin Kamber, Eckhard Mauermann","doi":"10.1177/10892532241286663","DOIUrl":"https://doi.org/10.1177/10892532241286663","url":null,"abstract":"<p><strong>Objectives: </strong>To examine whether estimates of peak global systolic (S') and diastolic (E') left ventricular (LV) flow rates based on 3D echocardiographic volumes are feasible and match physiology.</p><p><strong>Methods: </strong>In this retrospective feasibility study, we included patients undergoing major cardiac surgery. S' and E' were derived from 190 patients by taking the first derivative of the volume-time relationship of 3D ecg-gated transesophageal echocardiography (TEE) images. To examine the quality of images upon which the estimates of flow were based we correlated intraoperative 3D TEE and preoperative 2D transthoracic echocardiography (TTE) volumes. As a proof-of-concept, we then correlated S' flow with stroke volume and S' and E' were compared by valve pathology.</p><p><strong>Results: </strong>In each of the 190 images, S' and E' were derived. There was good correlation between 1) the ejection fraction (EF) of 3D LV images obtained intraoperatively by TEE and preoperatively by TTE (Pearson's r = 0.65) and also 2) S' and stroke volume (Pearson's r = 0.73). Patients with aortic or mitral regurgitation showed higher S' than patients without valve pathologies (-315 mL/s [95% CI -388 mL/s to -264 mL/s]<i>P</i> = 0.001, -319 mL/s [95% CI -397 mL/s to -246 mL/s]<i>P</i> = 0.001 vs -242 mL/s [95% CI -300 mL/s to -196 mL/s]). These patients also showed higher E' than patients without valve pathologies (302 mL/s [95% CI 237 mL/s to 384 mL/s]<i>P</i> = 0.006, 341 mL/s [95%CI 227 mL/s to 442 mL/s]<i>P</i> = 0.001 vs 240 mL/s [95%CI 185 mL/s to 315 mL/s]). Patients with aortic stenosis showed no difference in S' or E' (-263 mL/s [95%CI -300 mL/s to -212 mL/s]<i>P</i> = 0.793, 255 mL/s [95%CI 188 mL/s to 344 mL/s]<i>P</i> = 0.400).</p><p><strong>Conclusions: </strong>Estimates of global peak systolic and diastolic LV flow based on 3D TEE are feasible, promising, and match valve pathologies.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298353","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":"The Important Thing Is Not to Stop Questioning.","authors":"Daniel Haines, Ryan Grell, Jiapeng Huang, Benjamin Abrams, Miklos D Kertai","doi":"10.1177/10892532241279627","DOIUrl":"10.1177/10892532241279627","url":null,"abstract":"","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113309","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":"Perioperative and Anesthetic Considerations in Vascular Rings and Slings.","authors":"Michael Wadle, Denise Joffe, Carl Backer, Faith Ross","doi":"10.1177/10892532241234404","DOIUrl":"10.1177/10892532241234404","url":null,"abstract":"<p><p>Vascular rings represent an increasingly prevalent and diverse set of congenital malformations in which the aortic arch and its primary branches encircle and constrict the esophagus and trachea. Perioperative management varies significantly based on the type of lesion, its associated comorbidities, and the compromise of adjacent structures. Multiple review articles have been published describing the scope of vascular rings and relevant concerns from a surgical perspective. This review seeks to discuss the perioperative implications and recommendations of such pathology from the perspective of an anesthesia provider.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913746","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":"Management of Anticoagulation and Antifibrinolytics in Catastrophic Antiphospholipid Syndrome.","authors":"Jee Ha Park, Nazia Siddiqui, William K Hrebec, Trevor J Szymanski, Santiago Uribe-Marquez, Kyle G Miletic, Sandeep Krishnan","doi":"10.1177/10892532241249782","DOIUrl":"10.1177/10892532241249782","url":null,"abstract":"<p><p>Antiphospholipid syndrome (APS) is an autoimmune disorder that presents with hypercoagulability and results in a lab artifact of prolonged PTT. The most severe form is catastrophic antiphospholipid antibody syndrome (CAPS), which manifests as rapidly progressing thromboses in multiple organ systems leading to multi-organ ischemia. The mainstay management CAPS is anticoagulation and systemic corticosteroids. Antifibrinolytic agents have previously been thought to be relatively contraindicated in CAPS due to the pro-thrombotic nature of the disease; the complex coagulation profile of CAPS can make it difficult to assess the risks and benefits of antifibrinolytic therapy. Also, should a patient with CAPS require cardiopulmonary bypass (CPB) for surgery, it poses a unique challenge in providing appropriate anticoagulation in the setting of prolonged ACT. We present a case of a 32-year-old postpartum female with CAPS requiring heart transplant who safely received intraoperative antifibrinolytic therapy and was successfully anticoagulated during CPB after perioperative plasmapheresis.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853133","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":"Anesthetic Management of a Jehovah's Witness Patient for Coronary Artery Bypass Grafting With Antiphospholipid Antibody Syndrome and Renal Transplant.","authors":"Katherine Greco, Dirk Varelmann, Jonah Patel","doi":"10.1177/10892532241236117","DOIUrl":"10.1177/10892532241236117","url":null,"abstract":"<p><p>Anesthesia for cardiac surgical patients with antiphospholipid antibody syndrome (APLS) presents challenges with monitoring anticoagulation during cardiopulmonary bypass. Additionally, this condition is associated with other autoimmune diseases and comorbidities that need to be considered in caring for these patients, and there is minimal evidence for specific strategies during cardiac surgery. Separately, Jehovah's Witness (JW) patients typically do not consent to receiving blood products, presenting an additional challenge for resuscitation during cardiac surgery and especially in the context of APLS. We present our approach to the anesthetic management of a JW patient with systemic lupus erythematosus (SLE) complicated by APLS, thrombocytopenia, and renal failure with history of renal transplant who presented for coronary artery bypass surgery. Management strategies we recommend include administration of antifibrinolytics after heparinization to mitigate bleeding risk and interdisciplinary management with the perfusion, intensive care, surgical, and nephrology teams.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139944540","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":"A Review of Pediatric Cardiomyopathy.","authors":"Jenna S Schauer, Borah Hong","doi":"10.1177/10892532241250241","DOIUrl":"10.1177/10892532241250241","url":null,"abstract":"<p><p>Though pediatric cardiomyopathy is rare in children, there is significant associated morbidity and mortality. Etiology varies from inborn errors of metabolism to familial genetic mutations and myocyte injury. Major classes include dilated, hypertrophic, restrictive, and non-compaction. Diagnosis generally involves a combination of clinical history and echocardiography. The use of cross-sectional imaging is gaining popularity. Management varies between subtype and may involve a combination of medical and surgical interventions depending on clinical status.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869268","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":"A Multi-Country Survey on the Availability of Intraoperative Use of Echocardiography for Noncardiac Surgery.","authors":"Mohamed M El Tahan, Davy C Cheng, Laszlo Szegedi, Jannicke Mellin-Olsen, Marko Zdravkovic, Eric Benedet Lineburger, Daniela Filipescu, Luigi Tritapepe, Fabio Guarracino, Caetano Nigro Neto, Paula Camona Garcia, Miguel Ángel Rodenas Monteagudo, Manuel Gil Granell, Rosario Vicente Guillén, Philippe Gaudard, Ahmed Abdulmomen, Abdelazeem Ali Eldawlatly, Serban-Ion Bubenek-Turconi, Radu Stoica, Marc Licker, Gabor Erdoes, Eckhard Mauermann, Mikhail Kirov, Vladimir Lomivorotov, Vera Saldien, Mona Momeni, Jiapeng Huang","doi":"10.1177/10892532241256020","DOIUrl":"10.1177/10892532241256020","url":null,"abstract":"<p><strong>Background: </strong>This survey aimed to explore the availability and accessibility of echocardiography during noncardiac surgery worldwide.</p><p><strong>Methods: </strong>An internet-based 45-item survey was sent, followed by reminders from August 30, 2021, to August 20, 2022.</p><p><strong>Results: </strong>1189 responses were received from 62 countries. Nearly seventy-one percent of respondents had intraoperatively used transesophageal or transthoracic echocardiography (TEE and TTE, respectively) for monitoring or examination. The unavailability of echocardiography machines (30.3%), lack of trained personnel (30.2%), and absence of clinical indications (22.6%) were the top 3 reasons for not using intraoperative echocardiography in noncardiac surgery. About 61.5% of participants had access to at least one echocardiography machine. About 41% had access to at least 1 TEE probe, and 62.2% had access to at least 1 TTE probe. Seventy-four percent of centers had a procedure to request intraoperative echocardiography if needed for noncardiac cases. Intraoperative echocardiography service was immediately available in 58% of centers.</p><p><strong>Conclusions: </strong>Echocardiography machines and skilled echocardiographers are still unavailable at many centers worldwide. National societies should aim to train a critical mass of certified TEE/TTE anesthesiologists and provide all anesthesiologists access to perioperative TEE/TTE machines in anesthesiology departments, considering the increasing number of older and sicker surgical patients scheduled for noncardiac surgery.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261775","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":"Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip: Transcatheter Mitral Valve Repair.","authors":"Ashwin Vaidyanathan, Jayakar Guruswamy, Abhishek Saluja, Marvin Eng, Trevor Szymanski","doi":"10.1177/10892532241260535","DOIUrl":"10.1177/10892532241260535","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge repair (TEER) with MitraClip is a safe and effective alternative to surgical mitral valve repair/replacement in patients with high operative risk. Pleth Variability Index (PVI) is a non-invasive, dynamic index based on analysis of the respiratory variations in the plethysmographic waveform recorded transcutaneously by the pulse oximeter.</p><p><strong>Objectives: </strong>The objective of the study was to evaluate if the hemodynamic effect of improved left-sided output after successful transcatheter mitral valve repair would lead to a significant change in PVI, and if it would correlate with the decrease in left atrial pressure (LAP).</p><p><strong>Design: </strong>Prospective, observational cohort study (ClinicalTrials.gov NCT03993938).</p><p><strong>Setting: </strong>Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021.</p><p><strong>Participants: </strong>The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement.</p><p><strong>Measurements and main results: </strong>Of 30 patients, all components of the LAP (<i>a</i> wave, <i>v</i> wave, and mean) decreased significantly after successful MitraClip placement (<i>P</i> < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (<i>P</i> = .275). No significant correlation between change in PVI and change in LAP was observed (<i>P</i> = .235).</p><p><strong>Conclusions: </strong>In patients with severe mitral regurgitation, successful MitraClip resulted in a significant reduction in LAP without a significant change in PVI. A larger sample size may provide more insight on the utility of using PVI as an indicator of LAP change in patients with mitral regurgitation.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307095","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":"Intracardiac Echocardiography-Applications in the Electrophysiology and the Cardiac Catheterization Labs.","authors":"Rahul Myadam, Jeffrey Kolominsky, Pranav Mankad, Jayanthi Koneru","doi":"10.1177/10892532241267351","DOIUrl":"https://doi.org/10.1177/10892532241267351","url":null,"abstract":"<p><p><i>Background.</i> Intracardiac echocardiography (ICE) is routinely used in cardiac electrophysiology and catheterization labs. It plays a vital role in understanding cardiac anatomy, procedural planning, and early identification of complications. In this review, we describe the utility of ICE for procedures in the electrophysiology lab, including atrial fibrillation ablation, left atrial appendage occlusion device implantation, and cardiac implantable electronic device (CIED) extraction. Intracardiac echocardiography also helps in the identification of complications such as pericardial effusion, pulmonary vein stenosis, and left atrial appendage thrombus. Compared with traditional echocardiographic modalities such as transesophageal echocardiogram (TEE), ICE has equivalent image quality, requires less sedation, and possesses no risk of esophageal injury. The disadvantages of ICE include a learning curve and necessity for central vascular access.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749245","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":"The Year in Review: Anesthesia for Congenital Heart Disease 2023.","authors":"Michael Wadle, Leah Landsem, Gregory Latham, Faith Ross","doi":"10.1177/10892532241244475","DOIUrl":"10.1177/10892532241244475","url":null,"abstract":"<p><p>This review highlights published literature in 2023 that is related to the anesthetic management of patients with congenital heart disease (CHD). Though not inclusive of all topics, 31 articles are discussed and four primary themes emerged: transfusion and hemostasis, outcomes and risk assessment, monitoring, and pharmacology.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337178","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}