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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.Transesophageal Echocardiography-Guided Extracorporeal Membrane Oxygenation Cannulation in COVID-19 Patients
A paucity of data supports the use of transesophageal echocardiography (TEE) for bedside extracorporeal membrane oxygenation (ECMO) cannulation. Concerns have been raised about performing TEEs in patients with COVID-19. The authors describe the use and safety of TEE guidance for ECMO cannulation for COVID-19.Use of a Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion: A Multicenter Randomized Study
The objective of this multicenter study was to test the hypothesis of whether the use of a video laryngoscope (VL) reduces complications related to transesophageal echocardiography (TEE) probe insertion.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.Aortic Valve Repair Using HAART 300 Geometric Annuloplasty Ring: A Review and Echocardiographic Case Series
Aortic valve repair (AVr) aims to preserve the native aortic leaflets and restore normal valve function. In doing so, AVr is a more technically challenging approach than traditional aortic valve replacement. Some of the complexity of repair techniques can be attributed to the unique structure of the functional aortic annulus (FAA), which, unlike the well-defined mitral annulus, is comprised of virtual and functional components. Though stabilizing the ventriculo-aortic junction (VAJ), a component of the FAA, is considered beneficial for patients with chronic aortic insufficiency (AI), the ideal AVr technique remains a subject of much debate.Prospective Observational Trial of a Nonocclusive Dilatation Balloon in the Management of Tracheal Stenosis
TRACHEAL STENOSIS is a debilitating condition that is difficult to treat, requires multidisciplinary management, and yet often presents with severe respiratory compromise requiring urgent intervention. Emergency tracheostomy may be life-saving but impacts future definitive management by tracheal resection and reconstruction (TRR).1,2 Although considered the gold standard for the management of tracheal stenosis, TRR requires a high level of resources and still is associated with a significant rate of failure and restenosis.Assessing Skill Acquisition in Anesthesiology Interns Practicing Central Venous Catheter Placement Through Advancements in Motion Analysis
The study authors hypothesized that a combination of previously used (path length, translational motions, and time) and novel (rotational sum) motion metrics could be used to analyze learning curves of anesthesiology interns (postgraduate year 1) practicing central venous catheter placement in the simulation setting. They also explored the feasibility of using segmented motion recordings to inform deliberate practice.An Approach to Standard Perioperative Transthoracic Echocardiography Practice for Anesthesiologists—Perioperative Transthoracic Echocardiography Protocols
The use of intraoperative transesophageal echocardiography (TEE) has become the standard of care for most cardiac surgical procedures. There are guidelines established for training, practice, and quality improvement in perioperative TEE by the joint efforts of the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists. Cardiac point-of-care ultrasound (POCUS) increasingly is being incorporated into anesthesiologists’ training and practice. While a special “certification in Critical Care Echocardiography” was created by the National Board of Echocardiography in 2019, there currently exist no guidelines for training, certification, and practice of perioperative TTE by anesthesiologists.Mitral Valve Cleft-like Indentations in Hypertrophic Obstructive Cardiomyopathy: Insights From Intraoperative Three-Dimensional Transesophageal Echocardiography
Cleft-like indentations (CLIs) of the mitral valve (MV) are best assessed with three-dimensional (3D) transesophageal echocardiography (TEE). The present study examined the prevalence, characteristics, and surgical effect of MV CLIs in patients with hypertrophic cardiomyopathy (HCM).Simplified Algorithm for Evaluation of Perioperative Hypoxia and Hypotension (SALVATION): A Practical Echo-guided Approach Proposal
Despite the valuable use of modern applications of perioperative ultrasound across multiple disciplines, there have been limitations to its implementation, restricting its impact on patient-based clinical outcomes. Point-of-care ultrasound evaluation of hypoxia and hypotension is an important tool to assess the underlying undifferentiated etiologies in a timely manner. However, there is a lack of consensus on the formal role of ultrasound during evaluation of perioperative hypoxia or hypotension.Syringe-Free, Long-Axis in-Plane Versus Short-Axis Classic out-of-Plane Approach for Ultrasound-Guided Internal Jugular Vein Catheter Placement in Critically Ill Children: A Prospective Randomized Study
Although pediatric central venous catheterization is performed using ultrasound guidance, it is still a challenge. This study aimed to investigate the efficacy of the syringe-free, long-axis in-plane approach and compared the short-axis classic out-of-plane approach for ultrasound-guided central venous catheter placement in critically ill pediatric patients.Usefulness of Right Ventricular Longitudinal Shortening Fraction to Detect Right Ventricular Dysfunction in Acute Cor Pulmonale Related to COVID-19
RIGHT VENTRICULAR (RV) dysfunction, evaluated by echocardiography, is not a rare complication of coronavirus disease 2019 (COVID-19) infection, with an estimated incidence of 27%.1 RV systolic function is classically assessed with transthoracic echocardiography (TTE) by RV-fractional area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), or S′ tricuspid systolic (RV-S′) wave velocity obtained by tissue-Doppler imaging.2 More recently, two-dimensional speckle-tracking echocardiography (2D-STE), a semi-automated angle-independent method, has been developed to evaluate the RV systolic function.Continuous Noninvasive Arterial Pressure Monitoring for Transcatheter Aortic Valve Replacement
The objective of the present study, which was conducted in patients undergoing transcatheter aortic valve replacement, was to compare continuous noninvasive arterial pressure measured with the ClearSight device (Edwards Lifesciences, Irvine, CA) with invasive radial artery pressure used as the reference method. The authors hypothesized that the ClearSight device is an accurate, precise, safe, and efficient method for arterial blood pressure measurement comparable with an invasive radial arterial line.
