{"title":"Embracing the 'NORCA' Revolution: From Operating Room 'Marathon' to Cathlab 'Sprints'.","authors":"Devarakonda V Bhargava, Mukul Kapoor","doi":"10.4103/aca.aca_153_25","DOIUrl":"10.4103/aca.aca_153_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"216-218"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590206","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}
Katharina Seuthe, Eva Gerwin, Parwis Rahmanian, Bernd W Böttiger, Deepak Borde, Jakob Labus
{"title":"Intraoperative Course of Left Ventricular Diastolic Strain in Surgical Valve Replacement for Severe Aortic Valve Stenosis.","authors":"Katharina Seuthe, Eva Gerwin, Parwis Rahmanian, Bernd W Böttiger, Deepak Borde, Jakob Labus","doi":"10.4103/aca.aca_246_24","DOIUrl":"10.4103/aca.aca_246_24","url":null,"abstract":"<p><strong>Purpose: </strong>Assessment of LV diastolic dysfunction (LVDD) poses challenges due to the dynamic changes of loading conditions in the perioperative course. Diastolic strain-based measures showed to be less load dependent, but data in aortic valve replacement (AVR) surgery remains sparse to date. Therefore, we aimed to explore the feasibility to assess these measurements and to describe the intraoperative course in this patient population.</p><p><strong>Methods: </strong>Prospective observational study including 30 adult patients. Intraoperative transesophageal echocardiography (TEE) was performed after induction of anesthesia [T1], after termination of cardiopulmonary bypass [T2], and after sternal closure [T3]. TEE assessment included the evaluation of peak longitudinal strain rate during isovolumetric relaxation (SR-IVR), early (SR-E) and late (SR-A) LV filling, as well as of conventional echocardiographic measurements and LVDD grading algorithms.</p><p><strong>Results: </strong>Diastolic strain analysis was feasible in 27 (90%) AVR patients at all time points of assessment. LV diastolic strain improved significantly after AVR [T1 vs T3] as measured by SR-IVR (0.31 s-1 (IQR 0.22; 0.38) vs. 0.4 s-1 (IQR 0.33; 0.43); P = 0.01), SR-E (1.13 s-1 (IQR 0.89;1.28) vs. 1.35 s-1 (IQR 1.10;1.52); P = 0.035), and E/SR-IVR (2.2 m (IQR 1.7;2.8) vs. 1.6 m (IQR 1.3;2.2); P = 0.013). In contrast, conventional echocardiographic measurements and grading algorithms were not able to detect these changes in the same period.</p><p><strong>Conclusion: </strong>Assessment of LV diastolic strain was feasible in our group of selected AVR patients. LV relaxation and filling improved during the intraoperative course of AVR as measured by diastolic strain, while most conventional grading algorithms were not able to detect these alterations.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"264-272"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590300","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}
Himani V Bhatt, Dhruv Patel, Dillon Rogando, Jordan Abrams, Ali Shariat
{"title":"Multimodal Analgesia in Cardiothoracic Procedure: Opioid and Non-opioid Pharmacology for Pain Management: Part 1.","authors":"Himani V Bhatt, Dhruv Patel, Dillon Rogando, Jordan Abrams, Ali Shariat","doi":"10.4103/aca.aca_215_24","DOIUrl":"10.4103/aca.aca_215_24","url":null,"abstract":"<p><strong>Abstract: </strong>Pain in the context of cardiothoracic surgery can be attributed to multiple factors. Furthermore, cardiothoracic procedure-related pain can be significant and can lead to multiple morbidities including chronic pain syndromes when left undertreated. Even though opioids remain mainstay of treatment for these procedures, opioid-sparing techniques utilizing a well-developed multimodal regimen can be important in the proper pain management of this patient population. It is imperative for the anesthesiologist to understand the multiple pharmacological and non-pharmacological modalities available, the benefits and adverse effects, and the literature supporting the utility of these methods.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"228-237"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590304","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":"Comment on: \"Assessment of Right Ventricle Function in Patients with Mitral Repair: Case Series\".","authors":"Rohan Magoon, Brajesh Kaushal","doi":"10.4103/aca.aca_20_25","DOIUrl":"10.4103/aca.aca_20_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 3","pages":"341-342"},"PeriodicalIF":1.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590204","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":"Innovative Use of Pulmonary Artery (PA) Catheter for Lung Isolation in a Pediatric Patient: A Case Report.","authors":"Vijaya Kumara","doi":"10.4103/aca.aca_191_24","DOIUrl":"https://doi.org/10.4103/aca.aca_191_24","url":null,"abstract":"<p><strong>Abstract: </strong>Lung isolation is essential for optimal surgical exposure and prevents contamination of normal lung. It is challenging in pediatric patients due to the anatomical and physiological differences. The most common methods of achieving lung isolation include the use of double-lumen endotracheal tubes (DLTs) or bronchial blockers (BBs). However, in pediatric patients, the size of the airways often restricts the use of DLTs, and in some cases, specific BBs may not be available or feasible due to the anatomy. Here, we report a case of right lower lobectomy in a two-and-half-year-old child using a pulmonary artery (PA) catheter to isolate the lung.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"176-178"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972923","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}
A Kireeti, Ravikanth Pula, T Nagarjuna, T Rabbani, R Gopinath
{"title":"Effect of Transesophageal Echocardiography Probe Insertion on Endotracheal Tube Cuff Pressure in Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery. A Prospective Randomized Control Trial.","authors":"A Kireeti, Ravikanth Pula, T Nagarjuna, T Rabbani, R Gopinath","doi":"10.4103/aca.aca_175_24","DOIUrl":"https://doi.org/10.4103/aca.aca_175_24","url":null,"abstract":"<p><strong>Introduction: </strong>Elevated endotracheal tube (ETT) cuff pressures during surgery can lead to tracheal ischemia and airway complications, including postoperative sore throat, subglottic edema, and tracheal stenosis. The insertion of a transesophageal echocardiography (TEE) probe, commonly used in cardiac surgeries, may increase ETT cuff pressure due to its proximity to the trachea. This study assesses the impact of TEE probe insertion on ETT cuff pressures and related postoperative airway complications in patients undergoing coronary artery bypass graft (CABG) surgery.</p><p><strong>Methods: </strong>In this prospective, randomized controlled trial, 40 patients undergoing CABG were assigned to either a control group (Group C, n = 20) or an intervention group (Group T, n = 20). Cuff pressures were monitored at baseline (T1), during TEE probe manipulation (T2), after initial examination (T3), and during recovery (T4). In Group T, cuff pressures were adjusted to 20-30 cmH2O if they exceeded 30 cmH2O during T2 and T3. Postoperative complications, including sore throat, hoarseness, and cough, were assessed using standardized scales.</p><p><strong>Results: </strong>TEE probe manipulation significantly increased ETT cuff pressures in both groups, with lower pressures consistently observed in Group T (P < 0.05). At T3, the mean cuff pressure in Group C was 41.00 cmH2O versus 33.30 cmH2O in Group T (P < 0.001). The control group experienced more severe postoperative airway complications, while Group T had a significantly reduced risk of severe complications (odds ratio < 0.2).</p><p><strong>Conclusion: </strong>TEE probe manipulation significantly increases ETT cuff pressures, but cuff deflation during manipulation effectively reduces these pressures and lowers the risk of postoperative airway complications.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"143-148"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969515","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":"The Mechanisms and Pathophysiology of Mitral Regurgitation: A Narrative Review.","authors":"Praveen Kumar Neema, Nagarjuna Panidapu","doi":"10.4103/aca.aca_221_24","DOIUrl":"https://doi.org/10.4103/aca.aca_221_24","url":null,"abstract":"<p><strong>Abstract: </strong>Mitral valve closure is a complex process and requires coordinated actions of all its interrelated anatomical components: the left atrium, the mitral annulus, the valve leaflets, the tendinous chordae, and the papillary muscles with its surrounding left ventricular wall for an effective mitral valve closure. Research of last three-decades has shown that the mitral annulus starts contracting during atrial systole which significantly prevent early mitral regurgitation (MR). MR can be acute or chronic, and primary, or secondary or mixed; their etiologies, mechanisms and natural progression are very different and have clinical implications. A leaflet perforation, a rupture of chorda tendinea or papillary muscle and a torn leaflet after balloon mitral valvotomy can result in acute severe MR. The patients of acute severe MR present in pulmonary edema and cardiogenic shock and often need urgent surgical intervention. Primary MR is a disease of the mitral valve apparatus and secondary to valve degeneration, whereas secondary MR is a disease of the left ventricle secondary to coronary artery disease and dilated cardiomyopathy. The other causes of secondary MR include mitral annular dilation secondary to atrial fibrillation and restrictive cardiomyopathy, dys-synchrony due to bundle branch block, right ventricular pacing and hypertrophic cardiomyopathy. The treatment strategy differs for primary and various subsets of secondary MR; hence, a thorough knowledge of the etiology, mechanisms and pathogenesis of MR is necessary to select appropriate management strategy and to decide when to intervene. The review discusses the mechanisms, and pathophysiology in acute, chronic, primary and secondary MR.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"109-118"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952516","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":"Communication Between Vascular Catheter Lumens: Safety Implications.","authors":"Gegal Pruthi, Ankita Dey, Dilraj Dhindsa","doi":"10.4103/aca.aca_203_24","DOIUrl":"https://doi.org/10.4103/aca.aca_203_24","url":null,"abstract":"<p><strong>Abstract: </strong>In this case, we report a rare manufacturing defect in a multi-lumen central venous catheter, where communication between lumens was discovered during a pre-use flush check. This defect raises significant safety concerns, including potential medication interference and inaccurate CVP readings. Vigilant pre-use testing and heightened awareness of such anomalies are crucial to preventing life-threatening complications.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"28 2","pages":"179-180"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956825","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":"Crack in Drainage Cannula During Minimally Invasive ASD Repair Surgery- Troubleshooting of an Unforeseen Complication.","authors":"Kumara Vijaya, Rai D Guruprasad, R Sumanth","doi":"10.4103/aca.aca_177_24","DOIUrl":"10.4103/aca.aca_177_24","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":"206-207"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662112","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}