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Source: Journal of Cardiothoracic and Vascular Anesthesia

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Total 207 results found since Jan 2013.

Driving the wrong way on a one-way street. Reversal of coronary flow in aortic regurgitation
Aortic regurgitation (AR) represents the quintessential left ventricular volume overload state. In contrast to mitral regurgitation, where the left ventricle (LV) ejects blood into both the relatively low pressure left atrium and higher-pressure aorta, in AR, the entirety of LV stroke volume is ejected into the relatively higher pressure aorta. The severity of AR is obviously related to the regurgitant volume ejected into the LV during diastole. When severe, the forward stroke volume available for tissue perfusion represents a minority of the cardiac output.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 7, 2023 Category: Anesthesiology Authors: Carey Kimmelstiel Tags: Editorial Source Type: research

A Woman With a History of Stroke and a Mass in the Aorta
A 65-YEAR-OLD WOMAN presented with an acute onset of slurred speech and left facial droop. She had a past medical history of Raynaud's disease, well-controlled hypertension, and moderate tricuspid regurgitation, which was being followed by serial transthoracic echocardiographic examinations. A duplex ultrasound of the carotid and vertebral arteries was negative, whereas a magnetic resonance imaging scan of her brain revealed a subacute embolic cerebral infarction. A transesophageal echocardiographic (TEE) examination also was performed during the workup, revealing the presence of moderate-to-severe tricuspid regurgitation ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 26, 2012 Category: Anesthesiology Authors: Robina Matyal, Angela Wang, Bilal Mahmood, Kamal Khabbaz, Feroze Mahmood Tags: Diagnostic Dilemmas Source Type: research

Pooled Estimates of Immediate and Late Outcome of Mitral Valve Surgery in Octogenarians: A Meta-analysis and Meta-regression
Objective: The authors evaluated the outcome of patients≥80 years undergoing mitral valve (MV) surgery.Design: Systematic review of the literature and meta-analysis.Setting: None.Participants: None.Interventions: None.Main Results: Twenty-four studies reporting on 5,572 patients ≥80 years of age who underwent MV surgery were included in this analysis. Pooled proportion of operative mortality was 15.0% (95% confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% CI 2.6-5.2), and dialysis was 2.7% (95% CI 0.5-4.9). Early date of study (p = 0.014), increased age (p = 0.006), MV replacement (p = 0.008), procedure other t...
Source: Journal of Cardiothoracic and Vascular Anesthesia - April 1, 2013 Category: Anesthesiology Authors: Fausto Biancari, Paola Schifano, Michele Pighi, Francesco Vasques, Tatu Juvonen, Giulia Vinco Tags: Original Articles Source Type: research

Anesthetic and Technical Considerations in Redo Coronary Artery Bypass Surgery Using Sternal-Sparing Approaches
REOPERATIVE CORONARY ARTERY bypass grafting (CABG) has decreased significantly in the previous 20 years, likely because of the increased availability of percutaneous coronary intervention (PCI). Reoperative surgery using the classic trans-sternal approach is more technically challenging than primary surgery and is associated with an increased risk of major complications and death. There is an increased risk of injury to patent bypass grafts, the great vessels, and right ventricle during sternal re-entry. Manipulation of the aorta or diseased bypass grafts can precipitate embolization and cause stroke or myocardial infarcti...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 9, 2012 Category: Anesthesiology Authors: Mitsuko Takahashi, Amanda J. Rhee, Farzan Filsoufi, George Silvay, Ramachandra C. Reddy Tags: Case Reports Source Type: research

High Thoracic Epidural Analgesia and Cardiac Performance
We read with interest the recent paper of CJ Jakobsen et al regarding high thoracic epidural analgesia (HTEA) in cardiac surgery. They studied 60 low-risk patients between 65 and 80 years of age scheduled for elective coronary artery bypass graft surgery with or without HTEA. They thought HTEA improved perioperative cardiac performance both before and after cardiopulmonary bypass, shown by a higher stroke volume index and cardiac index without increases in heart rate or mean arterial pressure. But we do not think so.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 14, 2013 Category: Anesthesiology Authors: Yong Xin Liang, He Dong, Yun Bo Sun Tags: Letters to the Editor Source Type: research

Chronic Pressure-Overload Hypertrophy Attenuates Vortex Formation Time in Patients With Severe Aortic Stenosis and Preserved Left Ventricular Systolic Function Undergoing Aortic Valve Replacement
Objective: Transmitral blood flow produces a vortex ring that enhances the hydraulic efficiency of early left ventricular (LV) filling. The effect of pressure-overload hypertrophy on the duration of LV vortex ring formation (vortex formation time [VFT]) is unknown. The current investigation tested the hypothesis that chronic LV pressure-overload hypertrophy produced by severe aortic stenosis (AS) reduces VFT in patients with preserved LV systolic function undergoing aortic valve replacement.Design: Observational study.Setting: Veterans Affairs Medical Center.Participants: After the Institutional Review Board's approval, 8 ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 3, 2013 Category: Anesthesiology Authors: Paul S. Pagel, Judith A. Hudetz Tags: Original Articles Source Type: research

Hemodynamic Pressure Waveform Analysis in Predicting Fluid Responsiveness
Objective: To assess the usefulness of central venous pressure (CVP), diastolic right ventricular pressure, and pulmonary capillary wedge pressure (PCWP) waveform analysis in predicting fluid responsiveness.Design: A prospective observational study.Setting: Tertiary care university hospital.Patients: Forty-four patients undergoing coronary artery bypass grafting.Interventions: Analysis of the a/v wave ratio of the PCWP, CVP, and right ventricular dP/dt to predict an increase in stroke volume>15% after the administration of 500mL of colloid.Measurements and Main Results: Forty-four patients were enrolled in this study and 7...
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 16, 2013 Category: Anesthesiology Authors: Sébastien Roy, Pierre Couture, Baqir Qizilbash, Francis Toupin, Sylvie Levesque, Michel Carrier, Jean Lambert, André Y. Denault Tags: Original Articles Source Type: research

HbA1c: A Prognostic Biomarker in the Surgical and Critically Ill Patient Population
HYPERGLYCEMIA CAN OCCUR as part of the catabolic response to stress. Acute hyperglycemia is associated with a poor outcome and increased mortality under a variety of clinical conditions, most notably myocardial infarction, stroke, and major surgical tissue trauma. Data from hospital admissions indicate that nondiabetic patients with newly diagnosed hyperglycemia have an increased risk of death. However, the evidence supporting a link between diabetes mellitus (DM) and increased mortality in critically ill and surgical patients is not as strong. This may be caused partly by the underdiagnosis of DM and, thereby, falsely lab...
Source: Journal of Cardiothoracic and Vascular Anesthesia - September 3, 2012 Category: Anesthesiology Authors: Justin Letourneau, Helen Bui, Thomas Schricker, Roupen Hatzakorzian Tags: Review Articles Source Type: research

Hemodynamic Pressure Waveform Analysis in Predicting Fluid Responsiveness
Objective: To assess the usefulness of central venous pressure (CVP), diastolic right ventricular pressure, and pulmonary capillary wedge pressure (PCWP) waveform analysis in predicting fluid responsiveness.Design: A prospective observational study.Setting: Tertiary care university hospital.Patients: Forty-four patients undergoing coronary artery bypass grafting.Interventions: Analysis of the a/v wave ratio of the PCWP, CVP, and right ventricular dP/dt to predict an increase in stroke volume>15% after the administration of 500mL of colloid.Measurements and Main Results: Forty-four patients were enrolled in this study and 7...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 1, 2013 Category: Anesthesiology Authors: Sébastien Roy, Pierre Couture, Baqir Qizilbash, Francis Toupin, Sylvie Levesque, Michel Carrier, Jean Lambert, André Y. Denault Tags: Original Articles Source Type: research

Effects of Catecholamines on Microcirculation During General Inhalation Anesthesia
Conclusions: During general anesthesia with sevoflurane, the infusion of clinical dosages of norepinephrine and dobutamine did not alter sublingual perfusion, although the expected systemic hemodynamic alterations were induced.
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 22, 2013 Category: Anesthesiology Authors: Paolo Chiarandini, Livia Pompei, Maria Gabriella Costa, Luigi Vetrugno, Fortunato Ronga, Roberta Contin, Fabio Rosa, Giorgio Della Rocca Tags: Original Article Source Type: research

Black Box Warning: Is Ketorolac Safe for Use After Cardiac Surgery?
Objective: In 2005, after the identification of cardiovascular safety concerns with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), the FDA issued a black box warning recommending against the use of NSAIDs following cardiac surgery. The goal of this study was to assess the postoperative safety of ketorolac, an intravenously administered NSAID, after cardiac surgery.Design: Retrospective observational study.Setting: Single center, regional hospital.Participants: A total of 1,309 cardiac surgical patients (78.1% coronary bypass, 28.0% valve) treated between 2006 and 2012.Interventions: A total of 488 of these patie...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 13, 2013 Category: Anesthesiology Authors: Lisa Oliveri, Katie Jerzewski, Alexander Kulik Tags: Original Articles Source Type: research

Retrosternal Hematoma After Aortic Valve Replacement: Ultrasound View
We report a case of hemodynamic compromise secondary to an extrapericardial compression caused by the acute formation of a retrosternal hematoma, and we discuss the value of bedside echocardiography after cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 24, 2014 Category: Anesthesiology Authors: Vladimir V. Merenkov, Ivan S. Koshcheev, Yuri E. Monahov, Dmitry A. Movchan Tags: Letters to the Editor Source Type: research

Cardiac Output Calculation and Three-Dimensional Echocardiography
Conclusions: LVOT area is underestimated with the single- axis 2D method when compared with 3D planimetered area. This results in a CO that is approximately 10% lower with the 2D method.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 3, 2014 Category: Anesthesiology Authors: Mario Montealegre-Gallegos, Feroze Mahmood, Khurram Owais, Phillip Hess, Jayant S. Jainandunsing, Robina Matyal Tags: Original Articles Source Type: research

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