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CASE 3—2013: Maldistribution of Cardioplegia Detected by Transesophageal Echocardiography During Minimally Invasive Cardiac Surgery
MINIMALLY 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.Accessory Attachment
A 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 Reconstruction
ANESTHESIOLOGISTS 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 Revolution
THE 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.
