Air in the Moustache Can Choke the Left VentricleAORTIC ROOT PATHOLOGIES often require complex surgical repair techniques due to the involvement and manipulation of the coronary arteries. In 1981, Cabrol et al described a technique to reimplant the coronary arteries into the aortic conduit using a Dacron tube graft.1 In the 1980s and 1990s, the Cabrol technique and its modifications commonly were performed during aortic root surgery, but now are used less frequently due to the development of improved coronary ostial button mobilization techniques.
Residual Left Atrial Mass After Myxoma ResectionA 68-YEAR-OLD WOMAN was admitted to the authors’ institution complaining of shortness of breath and chest pain. Her workup demonstrated a large (5 cm×5 cm) atrial mass by transthoracic echocardiography. She subsequently was scheduled for resection. On the day of surgery, transesophageal echocardiography confirmed the presence of this large, pedunculated left atrial mass, which originated from the interatrial septum just proximal to the orifice of the right superior pulmonary vein. Its visual appearance resembled that of a myxoma.
CASE 3—2013: Maldistribution of Cardioplegia Detected by Transesophageal Echocardiography During Minimally Invasive Cardiac SurgeryMINIMALLY INVASIVE cardiac surgery is becoming increasingly and has advantages, but it involves decreased surgical exposure. The authors report a case in which a minimally invasive approach to the aortic valve precluded manual palpation of the left ventricle during administration of antegrade cardioplegia. Transesophageal echocardiography (TEE) showed maldistribution of cardioplegia, with the solution entering the left ventricle and, subsequently, left atrium, through incompetent aortic and mitral valves.
Mitral Valve Mass Detected on Preoperative Transesophageal EchocardiogramA 45-YEAR-OLD WOMAN with past medical history significant for hypertension, asthma, and anemia was admitted to the authors' institution with complaint of dyspnea on exertion. A preoperative transthoracic echocardiogram showed moderate-to-severe aortic regurgitation, mild dilatation of the sinus of valsalva and ascending aorta and mild decrease in left ventricular function with an ejection fraction equal to 48%. The patient was scheduled for an aortic valve replacement and possible aortic root replacement.
A Mitral Valve Mass: Tumor, Thrombus, or Vegetation?A 58-YEAR-OLD man developed transient monocular visual loss in the right lower quadrant of the left eye that fully resolved in less than 24 hours. He was afebrile and had no other symptoms. His known medical history included well-controlled arterial hypertension and dyslipidemia. He denied a history of cerebrovascular disease, atrial fibrillation, intravenous drug use, and thromboembolic disease. Medical evaluation included a carotid Doppler ultrasound that showed no abnormality, an unremarkable brain magnetic resonance imaging (MRI) examination, an unremarkable ophthalmologic examination, and a normal white blood cell count.
Manifestation of Aortic Root Abscess From Acute Bacterial EndocarditisA 71-YEAR-OLD man with a history of coronary artery disease, moderate aortic stenosis, and arterial hypertension was scheduled for aortic valve replacement and possible aortic root replacement. One month before admission, he was treated for methicillin-sensitive Staphylococcus aureus endocarditis. A transthoracic echocardiogram revealed a lesion on the mitral valve that was suspected to be a vegetation associated with mild mitral regurgitation. The patient began a course of intravenous oxacillin as an outpatient.
Accessory AttachmentA 60-YEAR-OLD MAN with a past medical history significant for obesity, hypertension, hypercholesterolemia, and a longstanding murmur presented with shortness of breath and fatigue with exertion over a period of 1 week. A transthoracic echocardiogram showed moderate aortic stenosis. A cardiac catheterization was performed and showed severe aortic stenosis (peak gradient of 70 mmHg and valve area of 0.64 cm2), single-vessel coronary artery disease (60%-70% occlusion of mid-left anterior descending artery), and dilation of the ascending aorta (5 cm).
Intraoperative Classification of Mitral Valve Dysfunction: The Role of the Anesthesiologist in Mitral Valve ReconstructionANESTHESIOLOGISTS cannot concentrate solely on advances made within the specialty, but must also keep up with developments occurring within the field of surgery because the surgical management of the patients partly determines the anesthetic management. Mitral valve disease and its surgical therapy represent a very dynamic area within the field of cardiac surgery. Thanks to better understanding of the anatomy of the mitral valve apparatus, pathophysiology of underlying disease processes, and improvements in surgical technique, a shift has taken place clearly favoring mitral valve repair over mitral valve replacement for regurgitant lesions.
Real-time Three-Dimensional Transesophageal Echocardiography: The Matrix RevolutionTHE ABILITY TO perform and interpret a comprehensive 2-dimensional transesophageal echocardiographic (2D-TEE) examination is a cornerstone to the modern-day practice of cardiac anesthesia and is inherently linked to the subspecialty. As with most technologies, echocardiography has seen numerous advancements evolve over time. The most significant of these advances that have occurred over the course of the past 50 years includes the progression from 1 (spatial)-dimensional imaging (A- and M-mode) to that of 2-dimensional (2D) imaging, as is currently in use today.
Noncompaction Cardiomyopathy: Case Report and Echocardiographic FindingsNONCOMPACTION CARDIOMYOPATHY (NCCMP) is a rare congenital cardiomyopathy characterized by multiple prominent trabeculations and recesses in the endo/myocardium of a noncompacted left ventricle. The clinical presentation can be very variable, ranging from an asymptomatic patient to one with symptoms of extreme congestive heart failure, arrhythmias, and/or systemic thromboembolic events. Although the pathogenesis of NCCMP remains the subject of debate, the most likely cause is thought to be arrest during embryologic development of the endocardium and myocardium.
Real-Time Three-Dimensional Transesophageal Echocardiographic Imaging of Endomyocardial FibrosisTHE FIRST CASE OF real-time 3-dimensional (3D) transesophageal echocardiography (TEE) imaging of an intracardiac mass is reported. Histologic examination later confirmed the diagnosis of endomyocardial fibrosis (EMF). The utilization of real-time 3D imaging to improve the understanding of the precise anatomic location and the dynamic relationship between this rare intracardiac mass and the surrounding anatomic structures during the cardiac cycle is described. Additionally, a brief review of EMF is provided.