Annals of Cardiac Anaesthesia最新文献

{"title":"Intraoperative Echocardiography as a Cornerstone in Anesthetic Care for Mayo Level IV Clear Cell Renal Cell Carcinoma with Cavoatrial Invasion in a Patient with Sickle Cell Trait.","authors":"Avinash Chauhan, Madan M Maddali, Swaroopa Ghatnatti, Is'haq Al Aamri","doi":"10.4103/aca.aca_215_25","DOIUrl":"10.4103/aca.aca_215_25","url":null,"abstract":"<p><strong>Abstract: </strong>This case report describes the successful perioperative anesthetic management of a 60-year-old woman with Mayo Level IV clear cell renal cell carcinoma and sickle cell trait who underwent radical nephrectomy, inferior vena cava thrombectomy, and right atrial thrombus excision under cardiopulmonary bypass. The anesthetic challenges included a large intracardiac mass with a high probability of producing mechanical obstruction across the right ventricular inflow and embolization, risk of massive hemorrhage, and perioperative concerns related to sickle cell trait. Intraoperative transesophageal echocardiography helped in thrombus surveillance, vascular access, cannulation guidance, and tumor clearance verification. Surrogate markers identified a subclinical hemolytic event.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"402-407"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Another Marker of Inflammation and Oxidative Stress and Its Impact on Myocardial Function, Arterial Elastance, and Vasoactive-Inotropic Score After Coronary Revascularization Surgery: A Prospective Cohort Study.","authors":"Teuku A Husain, Johanes N E Putranto, Philia Setiawan, Nancy M Rehatta, Fajar Perdhana, Yos Kowara","doi":"10.4103/aca.aca_34_26","DOIUrl":"10.4103/aca.aca_34_26","url":null,"abstract":"<p><strong>Context: </strong>Inflammatory and oxidative stress responses are markedly amplified following cardiopulmonary bypass (CPB), contributing to myocardial injury, vascular dysregulation, and potential multiorgan dysfunction.</p><p><strong>Aims: </strong>This study aimed to define how inflammatory, oxidative, and cellular stress responses quantified by tumor necrosis factor-alpha (TNF-α), hydroxyl (OH-) radical scavenging capacity, and heat shock protein-70 (HSP-70) relate to early postoperative myocardial contractility, arterial tone, and vasoactive-inotropic requirements after CPB.</p><p><strong>Settings and design: </strong>A prospective cohort study was conducted in patients undergoing coronary artery bypass grafting (CABG) with preserved preoperative ejection fraction (EF).</p><p><strong>Methods and materials: </strong>Postoperative biomarker levels and perioperative changes in TNF-α, OH- scavenging capacity, and HSP-70 with early myocardial contractility maximum rate of rise of left ventricular pressure (dP/dtmax), arterial elastance, and vasoactive-inotropic score were assessed.</p><p><strong>Statistical analysis used: </strong>Correlation analyses were performed using Pearson's or Spearman's correlation coefficients as appropriate.</p><p><strong>Results: </strong>A total of 52 patients were included in the study. Higher postoperative HSP-70 levels were associated with reduced early myocardial contractility (r = -0.315; P = 0.025) and increased vasoactive-inotropic requirements (ρ =0.341; P = 0.014). No significant associations were observed among postoperative biomarker variables, and changes in TNF-α or OH- scavenging capacity were not related to early postoperative hemodynamic outcomes (all P > 0.05).</p><p><strong>Conclusions: </strong>Early post-CPB myocardial dysfunction appears more closely associated with cellular stress (HSP-70) than with inflammatory or oxidative responses. Elevated HSP-70 levels in the early postoperative CABG may act as damage-associated molecular patterns associated with transient myocardial depression and higher vasoactive-inotropic requirements, whereas early inflammatory and oxidative changes showed no direct hemodynamic correlation.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"359-366"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failed Ventrain Device! Spontaneous Bag-Mask Ventilation Revisited as a Rescue Procedure in a Case of Recurrent Tracheal Stenosis with Dilated Cardiomyopathy.","authors":"Sanjula Virmani, Soumya Gupta, Ravi Meher, Rachna Wadhwa, Harpreet Singh","doi":"10.4103/aca.aca_209_25","DOIUrl":"10.4103/aca.aca_209_25","url":null,"abstract":"<p><strong>Abstract: </strong>This case report discusses the anesthetic management of a 47-year-old female with recurrent adenocystic carcinoma of the trachea and dilated cardiomyopathy (DCMP) undergoing tracheal tumor debulking and stenting. The patient experienced hemodynamic collapse due to failed expiration during ventilation using a Ventrain device, necessitating a return to spontaneous bag-mask ventilation and an urgent tracheostomy to maintain the airway.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"434-437"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Preoperative B-blocker Therapy and Postoperative Atrial Fibrillation after Elective Ascending Aortic Surgery.","authors":"Foteini Ampatzidou, Rafail Ioannidis, Maria Nastou, Eleftheria Dalampini, Theodora Asteri, Georgios Drossos, Despoina Sarridou","doi":"10.4103/aca.aca_41_26","DOIUrl":"10.4103/aca.aca_41_26","url":null,"abstract":"<p><strong>Background: </strong>Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery and is associated with increased morbidity and mortality. Although b-blockers are commonly used for POAF prevention, their efficacy in patients undergoing elective surgery of the ascending aorta remains unclear.</p><p><strong>Aims: </strong>We aimed to evaluate the impact of chronic preoperative b-blocker therapy on the occurrence of POAF in patients undergoing elective ascending thoracic aortic surgery.</p><p><strong>Settings and design: </strong>This single-center, retrospective observational study included adult patients who underwent elective surgical aneurysm repair of the ascending aorta between 2012 and 2021.</p><p><strong>Materials and methods: </strong>Patients with a documented history of paroxysmal, persistent, or permanent atrial fibrillation were excluded. Acute aortic dissection cases were also excluded.</p><p><strong>Statistical analysis: </strong>Associations between preoperative b-blockers therapy and POAF, as well as postoperative clinical outcomes, were assessed using Chi-square tests and independent-samples t -tests.</p><p><strong>Results: </strong>A total of 214 patients were included in the analysis. POAF occurred in 46% of patients. Chronic preoperative b-blocker therapy was not significantly associated with the development of POAF ( P = 0.058). Among postoperative outcomes, stroke was significantly more frequent in patients who developed POAF ( P = 0.026), whereas no significant associations were observed with acute kidney injury, renal replacement therapy, reintubation, or in-hospital mortality.</p><p><strong>Conclusions: </strong>In patients undergoing elective ascending aortic surgery, chronic preoperative b-blocker therapy was not significantly associated with a reduced incidence of POAF. These findings suggest that POAF risk in aortic surgery may be influenced by factors beyond conventional pharmacological prophylaxis.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":"372-377"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Predictors of Postoperative Atrial Fibrillation Following Cardiac Surgery: A Systematic Review.","authors":"Jokevin Prasetyadhi, Andi Adil, Hisbullah, Syafri Kamsul Arif","doi":"10.4103/aca.aca_285_25","DOIUrl":"10.4103/aca.aca_285_25","url":null,"abstract":"<p><strong>Abstract: </strong>Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, with an incidence ranging from 10% to 65%, and is associated with increased risks of stroke, prolonged hospitalization, and mortality. This systematic review aimed to evaluate the incidence and identify predictors of POAF in adults undergoing cardiac procedures. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched PubMed, Europe PMC, and SAGE databases for English-language studies published between January 2020 and June 2025. Eligible studies included observational and experimental designs involving adults (>18 years) undergoing cardiac surgery. Two reviewers independently screened titles/abstracts, assessed full texts, extracted data, and evaluated quality using the Newcastle-Ottawa Scale and Joanna Briggs Institute tools. From 6598 initial records, 52 studies (32 prospective cohorts, 17 retrospective cohorts, and 3 cross-sectional) were included, encompassing diverse geographies, and surgical types (e.g., coronary artery bypass grafting, valve surgery). POAF incidence varied from 7.9% to 60.9%, highest in combined procedures (40%-50%), and valve surgery (30%-40%). Consistent predictors included advanced age (odds ratio 1.05-1.10/year), left atrial enlargement, valve surgery, comorbidities (hypertension, diabetes, renal dysfunction), prolonged cardiopulmonary bypass, inflammation (e.g. C-reactive protein, neutrophil-to-lymphocyte ratio), and oxidative stress markers (e.g. NOX2). Novel biomarkers like MR-proANP and gene panels showed potential. POAF remains multifactorial and burdensome; standardized monitoring and integrated risk models could enhance prediction and prevention, warranting further validation in multicenter trials.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":"314-324"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Pulmonary Embolism During Right Atrial Mass Excision: A Case Report on Intraoperative Rescue TEE.","authors":"Praveen K Neema, Barsha Sen, Nagarjuna Panidapu","doi":"10.4103/aca.aca_327_25","DOIUrl":"10.4103/aca.aca_327_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"453-455"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the Universal Definition of Myocardial Infarction: A Case for Extraluminal Coronary Occlusion as a Distinct Entity.","authors":"Bhargava V Devarakonda, Shrinivas V Gadhinglajkar, Mukul C Kapoor, Prafull Sharma, Markose L Paret","doi":"10.4103/aca.aca_340_25","DOIUrl":"10.4103/aca.aca_340_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"397-401"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embolic Stroke of Undetermined Source Following Surgical Atrial Septal Defect Closure with Dacron Patch in a Young Adult without Identifiable Risk Factors.","authors":"Tanachot Rattanakosonsri, Supakorn Srihattapadungkit, Ittichai Sakarunchai, Chusak Nudaeng","doi":"10.4103/aca.aca_339_25","DOIUrl":"10.4103/aca.aca_339_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"452-453"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' Perception of Information Provision Regarding Complications in Cardiac Surgery: A Thematic Analysis.","authors":"Nick J G Visschers, Maaike S Y Thio, Cindy M A de Bot, Peter G Noordzij, Thijs C D Rettig","doi":"10.4103/aca.aca_69_26","DOIUrl":"10.4103/aca.aca_69_26","url":null,"abstract":"<p><strong>Context: </strong>Patients receive preoperative information about possible postoperative complications, but little is known about how they perceive this information or how they understand the consequences when complications occur.</p><p><strong>Aim: </strong>This study explored how patients who experienced postoperative complications perceived preoperative information and how they understood the potential impact of those complications on their well-being.</p><p><strong>Materials and methods: </strong>A qualitative study was conducted with patients who had undergone elective coronary artery bypass grafting or valve surgery and experienced a postoperative complication (Clavien-Dindo ≥≥3B). A qualitative researcher conducted semi-structured telephone interviews. Thematic analysis was used to identify recurring themes.</p><p><strong>Results: </strong>Eight patients were interviewed. The most common complication was postoperative hemorrhage requiring rethoracotomy (n = 7). Six themes were identified: (1) Negative perceptions of risk communication, (2) Need for personalized aftercare, (3) Inadequate validation of emotional experiences, (4) Unawareness of perioperative information, (5) Diversity in patients' functioning and impact of complications, and (6) Discontinuity of care. Patients need a comprehensive explanation of complications that occurred, partly because they did not fully understand the consequences. Patients and family members needed emotional support during the perioperative period. Patients preferred follow-up care by the same physician within the same hospital.</p><p><strong>Conclusion: </strong>Patients who experienced complications after cardiac surgery expressed a desire for more detailed discussions of complications and their consequences, increased emotional support, and continuity of care. Potential improvements in perioperative care in this specific patient group could include debriefing of complications, providing psychological support, and offering video or phone consultations.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"386-392"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Right Atrial Appendage Aneurysm with Thrombus Causing Cardiac Compression in Pulmonary Tuberculosis.","authors":"Sharek Abdul Nazir, Subrata Kumar Singha, Gade Sandeep, Anil Gupta, T C Arun","doi":"10.4103/aca.aca_289_25","DOIUrl":"10.4103/aca.aca_289_25","url":null,"abstract":"<p><strong>Abstract: </strong>Right atrial appendage aneurysm (RAAA) is a rare cardiac anomaly, predominantly considered congenital, resulting from dysplasia or localized absence of atrial myocardium leading to thinning and aneurysmal dilation. However, this case highlights the possibility of an acquired mechanism, particularly in the context of chronic infectious and inflammatory conditions such as tuberculosis (TB), which may have contributed to aneurysm formation in this patient. The patient's presentation with the left-sided chest pain and weight loss in the setting of active pulmonary TB raises clinical suspicion of an infectious etiology contributing to atrial wall weakening. Histopathological examination of the excised aneurysmal wall and thrombus was instrumental in confirming the diagnosis and etiopathogenesis. Surgical excision of the aneurysm and thrombus remains the cornerstone of management in symptomatic or complicated RAAA, particularly with chamber compression or thromboembolism risk. In this patient, postoperative recovery was uneventful, and continuation of anti-tubercular therapy was crucial to eradicate residual infection and prevent recurrence. Serial follow-up demonstrated no residual aneurysm or thrombus, stable right atrial and ventricular dimensions, and preserved cardiac function. The patient remained symptom-free without arrhythmias or embolic events, underscoring the importance of vigilant postoperative surveillance. This case not only broadens the differential for RAAA etiology to include infectious causes like TB, but also highlights the integral role of histopathological diagnosis and sustained postoperative monitoring for optimal patient outcomes.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"413-416"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}