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Measurement of stroke volume with echocardiography compared to gold standard cardiac magnetic resonance imaging An observational study
The assessment of Doppler-derived left ventricular outflow tract (LVOT) stroke volume (SV) is fundamental in outpatient, perioperative and critical care echocardiography.1 Calculation of SV allows assessment of the severity of aortic stenosis (AS) and evaluation of the haemodynamic state during undifferentiated hypotension.2 The use of focused transthoracic echocardiography (TTE) has appeal in a critical care environment, where after a single measurement of the LVOT area, pulsed wave Doppler velocity time integral (VTI) in the LVOT is used to calculate LVOT SV.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 16, 2023 Category: Anesthesiology Authors: Brian Cowie, Leah Wright, Ben Costello, Kristel Janssens, Erin Howden, Darragh Flannery, Steve Foulkes, Roman Kluger, Andre La Gerche Tags: Original Article Source Type: research

Invited Commentary on the Postpartum Preeclampsia ECMO Case Conference
PREGNANCY, DESPITE its common nature and reputation as a “natural stage” of female existence, has profound physiologic effects. The cardiovascular system evolves as early as 6 weeks' gestation to establish appropriate uteroplacental circulation to support a growing fetus and supply the increased demands on maternal metabolism.1 Cardiac output increase s throughout pregnancy and can reach up to 150% of prepregnancy levels by the twenty-fourth week, and is largely achieved by an increase in stroke volume; cardiac magnetic resonance imaging demonstrates increases in left ventricular end-diastolic volume and left ventricular mass.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 8, 2023 Category: Anesthesiology Authors: Kristin Constantine Trela Tags: Invited Commentary Source Type: research

Postpartum Preeclampsia and Extracorporeal Membrane Oxygenation
PREGNANCY, DESPITE its common nature and reputation as a “natural stage” of female existence, has profound physiologic effects. The cardiovascular system evolves as early as 6 weeks' gestation to establish appropriate uteroplacental circulation to support a growing fetus and supply the increased demands on maternal metabolism.1 Cardiac output increase s throughout pregnancy and can reach up to 150% of prepregnancy levels by the twenty-fourth week, and is largely achieved by an increase in stroke volume; cardiac magnetic resonance imaging demonstrates increases in left ventricular end-diastolic volume and left ventricular mass.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 8, 2023 Category: Anesthesiology Authors: Kristin Constantine Trela Tags: Invited Commentary Source Type: research

Invited Commentary to Postpartum Preeclampsia ECMO Case Conference
Pregnancy, despite its common nature and reputation as a “natural stage” of female existence, has profound physiological effects. The cardiovascular system evolves as early as six weeks gestation to establish appropriate uteroplacental circulation to support a growing fetus and supply the increased demands on maternal metabolism.1 Cardiac output incre ases throughout pregnancy and can reach up to 150% of pre-pregnancy levels by the twenty-fourth week and is largely achieved by an increase in stroke volume; cardiac magnetic resonance imaging demonstrates an increase in left ventricular end diastolic volume and left ventricular mass.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 8, 2023 Category: Anesthesiology Authors: Dr. Kristin Constantine Trela Tags: Invited Commentary Source Type: research

Neurologic Dysfunction and Neuroprotection in Transcatheter Aortic Valve Implantation
Transcatheter aortic valve implantation is a fast-growing procedure. Expanding to low-risk patients, it has surpassed surgical aortic valve implantation in frequency and has been associated with excellent outcomes. Stroke is a devastating complication after transcatheter aortic valve implantation. Silent brain infarcts identified by diffusion-weighted magnetic resonance imaging are present in most patients following transcatheter aortic valve implantation. Postoperative delirium and cognitive dysfunction are common neurologic complications.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 12, 2021 Category: Anesthesiology Authors: Kyle J. Riley, Lee-Wei Kao, Ying Low, Shika Card, Gem Manalo, Jeffrey P. Flemming, Michael K. Essandoh, Adam A. Dalia, Jason Z. Qu Tags: Review Article Source Type: research

A Case-Based Discussion on the Management of Cryptogenic Stroke and Patent Foramen Ovale in the Patient With a Hypercoagulable Disorder
UP TO 40% of all ischemic strokes are considered cryptogenic, implying a stroke without a definitive etiology.1,2 With a dearth of evidence-guided treatment strategies, the literature surrounding cryptogenic stroke is highly variable and not well-standardized. Even though existing guidelines do not specify the exact testing required, the cryptogenic stroke evaluation includes a variety of imaging modalities (eg, echocardiography, angiography, magnetic resonance imaging, carotid ultrasound) and laboratory investigations (eg, genetic testing, hypercoagulable disorder panels, erythrocyte sedimentation rate).
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 27, 2019 Category: Anesthesiology Authors: Neal S. Gerstein, Stacey D. Clegg, Daniel B. Levin, Adam C. Fish, Kirsten Tolstrup, Koki Nakanishi, Yuriko Yoshida, Shunichi Homma Tags: Case Conference Source Type: research

The influence of mean arterial pressure during cardiopulmonary bypass on cerebral complications
Stroke and postoperative cognitive dysfunction are common complications after cardiac surgery. Furthermore, silent strokes detected by diffusion-weighted magnetic resonance imaging (DWI) have been reported in up to 50% of cardiac surgery patients. The majority of these lesions seems to be caused by emboli, but other mechanisms may induce hypoperfusion and consequently lead to tissue ischaemia. A few randomised controlled trials have previously investigated the influence of mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) on cardiac and neurological endpoints with diverging results.
Source: Journal of Cardiothoracic and Vascular Anesthesia - April 1, 2017 Category: Anesthesiology Authors: Anne Gr ønborg Vedel, F Holmgaard, L Rasmussen, A Langkilde, OB Paulson, PS Olsen, T Lange, HB Ravn, JC Nilsson Source Type: research

Perfusion pressure cerebral infarction (PPCI trial - a protocol for a randomised clinical trial
Debilitating brain injury occurs in 1.6-5 % of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Diffusion-weighed magnetic resonance imaging (DWI) studies have reported stroke-like lesions in up to 51 % of patients after cardiac surgery. The majority of the lesions seem to be caused by emboli, but inadequate blood flow caused by other mechanisms may increase ischaemia in the penumbra or cause watershed infarcts. During CPB, blood pressure can be below the lower limit of cerebral autoregulation.
Source: Journal of Cardiothoracic and Vascular Anesthesia - April 30, 2016 Category: Anesthesiology Authors: Anne G Vedel, F Holmgaard, HB Ravn, JC Nilsson 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