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Where Should We Leave the Wild “Raa Raa” During Cardiopulmonary Bypass?
THE PULMONARY artery catheter (PAC), the Raa Raa, the noisy, wild lion in a British stop-motion animated children's television program1 (Fig 1), also known as the Swan-Ganz catheter, is used frequently during cardiac surgery. The PAC might provide clinicians with important information on the preload, afterload, and contractility through the measured and derived parameters for risks stratification and guide perioperative management, particularly in patients with advanced heart failure, pulmonary hypertension, cardiogenic shock, and those who undergo heart and lung transplantation and left ventricular assist device implantation.Ascending Aortic Pseudoaneurysm Fistulating into the Right Atrium: Vital Diagnosis via Intraoperative Transesophageal Echocardiography
THORACIC AORTIC PSEUDOANEURYSM is a rare complication after cardiovascular surgery, with an incidence <0.5%.1,2 A 54-year-old man presented with a large pseudoaneurysm (7.6 cm × 6.4 cm) of the proximal ascending aorta after undergoing an aortic valve replacement for bicuspid aortic valve disease (Fig 1). The patient complained of shortness of breath and fatigue. The patient was taken to the operating room for repair. An intraoperative transesophageal echocardiogram demonstrated a contained transmural rupture of the ascending aortic wall with continuous-flow jets from the aortic lumen toward the pseudoaneurysm in the upper esophageal ascending aortic short-axis view (Fig 2A, Video 1).“Ripples in Water” Effect Detected by Ultrasound During Internal Jugular Catheterization
Herein, I describe an interesting “ripples in water” effect in the right internal jugular vein using ultrasound guidance before its catheterization. A 54-year-old male with severe mitral stenosis, tricuspid regurgitation, pulmonary artery hypertension, and atrial fibrillation, was scheduled for mitral valve replacement. After the induction of anesthesia, the patient was positioned and prepared for a right internal jugular vein catheterization under ultrasound guidance. An ultrasound assessment revealed stasis of blood in the vessel and a “ripples in water” effect in a cross-sectional view (Fig 1; Video 1).Porcine Orthotopic Cardiac Xenotransplantation: The Role and Perspective of Anesthesiologists
ON JANUARY SEVENTH, 2022, the first genetically modified porcine cardiac xenograft was transplanted into a patient at the University of Maryland Medical Center. As members of the xenotransplant team and division of cardiac anesthesiology at the University of Maryland School of Medicine, the authors here had a role in this historic event. Cardiac xenotransplantation could become a common occurrence if it proves to be a viable answer for the limited supply of donor hearts to treat end-stage heart failure.Use of the Ventrain Ventilation Device and an Airway Exchange Catheter to Manage Hypoxemia During Thoracic Surgery and One-Lung Ventilation
HYPOXEMIA is a common challenge during one-lung ventilation (OLV),1,2 and first-line approaches for its management include assessing airway device position, increasing oxygen-inspired fraction (Fio2), optimizing ventilation, and applying continuous positive airway pressure to the nonventilated lung.3,4 The Ventrain (Ventinova Medical, Eindhoven, Netherlands) allows for ventilation through smaller internal diameter endotracheal tubes or smaller bore catheters. It is a handheld device with tubing for connection to an oxygen flow meter on one end and a male Luer Lock connector on the other end.Cardiac Hydatid Cyst Diagnosed Incidentally by Transesophageal Echocardiography After Cardiac Arrest
Hydatid cyst caused by echinococcus granulosus continues to be an endemic health problem in many countries. The liver (50%-70%) and lungs (5%-30%) are the most common locations for hydatid cysts. Cardiac hydatid cysts are found in fewer than 2% of patients.1 We present an uncommon case of cardiac hydatid cyst diagnosed incidentally by transesophageal echocardiography after cardiac arrest due to anaphylaxis that developed during liver hydatid cyst aspiration.One-Lung Ventilation to Accommodate Echocardiographic Guidance of the MitraClip
WE RECENTLY PUBLISHED an article by Musuku et al.1 in which we described the use of a combination of intracardiac echocardiography (ICE) by the cardiologist and transthoracic echocardiography (TTE) by the anesthesiologist for guidance of a MitraClip (Abbott, Abbott Park, IL) procedure in which transesophageal echocardiography (TEE) was not possible because of a newly diagnosed laryngeal mass. As a follow-up to that article, we present a patient in whom a large hiatal hernia prevented adequate TEE guidance, and lung isolation was used to dramatically improve image quality and accommodate a primarily TTE-guided approach for MitraClip.
