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Acute Cardiointestinal Syndrome Resulting From Postoperative Acute Biventricular Heart Failure
ACUTELY DECOMPENSATED HEART FAILURE (HF), if left untreated, causes organ hypoperfusion that can progress to irreversible and life-threatening multiorgan dysfunction. Cardiointestinal syndrome (CIS) is the result of both persistent venous congestion and hypoperfusion of the intestines as a result of biventricular HF.1 These mechanisms contribute to perturbations in normal intestine function that ultimately result in intestinal bacteria product translocation into the bloodstream.2 This translocation causes inflammatory cytokine production and sepsis, which depress myocardial function and eventually lead to biventricular heart failure, multiorgan failure, and death.Intraoperative Transesophageal Echocardiographic Findings in Surgical Resection of a Giant Right Atrial Diverticulum That Severely Compressed the Right Ventricle
A RIGHT ATRIAL (RA) diverticulum is a rare congenital malformation characterized by extraordinary cardiac enlargement that is often incidentally diagnosed by cardiac imaging.1–5 The etiology and optimal treatment of an RA diverticulum remain unclear because patients cases are asymptomatic. Although surgical resection is indicated for symptomatic patients, there have been no reports of intraoperative transesophageal echocardiography (TEE) of an RA diverticulum.Left Atrium Dissection: A Rare Cardiac Surgery Complication
LEFT ATRIAL DISSECTION is a rare complication of cardiac surgeries and usually is associated with mitral valve procedures. Typically, a false chamber is created through a tear of the mitral valve annulus extending into the left atrial wall. Transesophageal echocardiography (TEE) is used for diagnosis. The authors present a case of left atrial dissection that occurred after an ascending and transverse aortic arch aneurysm repair that was managed successfully conservatively.Cardiovascular Collapse in the Pregnant Patient, Rescue Transesophageal Echocardiography and Open Heart Surgery
ANESTHESIOLOGISTS with a practice in obstetrics must be acutely aware of the differential diagnosis of maternal cardiovascular collapse during pregnancy. The overall risk of maternal death is 6.5 in 100,000 deliveries and typically occurs in the third trimester.1 Deaths in the first and second trimesters are rare. The most common etiologies include pre-eclampsia (16%), amniotic fluid embolism (AFE) (14%), hemorrhage (12%), cardiac disease (11%), and pulmonary thromboembolism (9%). Less common etiologies include infection, medication error, and ectopic pregnancy.Incidental Finding of a Right Atrial Appendage Thrombus During Cardiac Surgery
RIGHT ATRIAL APPENDAGE (RAA) thrombi are encountered much less frequently than their left-sided counterparts. This difference is explained partly by dissimilarities in appendage anatomy and function. Atrial fibrillation (AF), right ventricular failure, and pulmonary hypertension are associated with RAA clots. Right atrial appendage thrombi remain a potential risk for serious embolic events and need to be addressed accordingly. The left atrial appendage (LAA) is studied routinely for the presence of thrombi in the setting of AF.CASE 12—2015: Tropheryma Whipplei Endocarditis
A 50−60-YEAR-OLD MAN with ongoing alcohol and methamphetamine abuse and a suspected history of intravenous drug use presented to the emergency department with a 1-month history of bilateral leg pain. Physical examination was significant for a cold left foot and absent left dorsalis pedis and tibialis posterior pulses. Auscultation revealed a 4/6 crescendo-decrescendo systolic murmur heard loudest over the right upper sternal boarder, and a 3/6 diastolic decrescendo murmur heard loudest over the right lower sternal boarder.Air in the Moustache Can Choke the Left Ventricle
AORTIC 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.Impairment of Venous Drainage Due to Atrial Septal Aneurysm During Open-Heart Surgery
IT IS NOT UNCOMMON to encounter inadequate venous drainage during cardiopulmonary bypass. Some common causes include poor positioning and obstruction of the venous cannula, increased resistance due to the small diameter of the venous cannula, and kinks in the tubing that connects the venous cannula to the venous reservoir. We report a case of atrial septal aneurysm (ASA) impairing venous drainage from a 2-stage venous cannula in right atrium during a routine cardiac surgery case requiring cardiopulmonary bypass (CPB).Acute Left Atrial Intramural Wall Dissection After Mitral Valve Replacement
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) has been used routinely in the diagnosis and follow-up of cardiac pathology. Left atrial (LA) dissection is a rare complication after mitral valve surgery. A case of LA dissection is presented, and the pathology was accurately defined and immediately diagnosed by using intraoperative TEE; the dissection was repaired at the time of surgery. This case highlights the importance of prompt diagnosis of LA dissection using intraoperative TEE, and a second cardiac surgery was avoided.An Unusual Shadow in the Left Atrium After Mitral Valve Replacement
A 55-YEAR-OLD male patient with increasing dyspnea on exertion and valvular heart disease was referred for surgery. A transthoracic echocardiogram revealed moderate mitral stenosis and mild mitral regurgitation with moderate pulmonary hypertension. In addition, thrombi were identified in the left atrium (LA) and left atrial appendage. In the operating room, transesophageal echocardiography (TEE) confirmed the preoperative findings. A 27-mm internal-diameter, ATS prosthetic valve (ATS Medical Inc, Minneapolis, MN) was placed in the mitral position, and LA and left atrial appendage thrombi were removed.Air Lock and Embolism Upon Attempted Initiation of Cardiopulmonary Bypass While Using Vacuum-Assisted Venous Drainage
VACUUM-ASSISTED VENOUS DRAINAGE (VAVD) for cardiopulmonary bypass (CPB) improves venous drainage via small cannulae.1 Complications specific to VAVD are important to anticipate and recognize. A case of air lock and air embolus upon initiation of CPB caused by overpressurization of the venous catheter is described. A description of indications and potential complications of VAVD is presented.Use of a Miniaturized Transesophageal Echocardiographic Probe in the Intensive Care Unit for Diagnosis and Treatment of a Hemodynamically Unstable Patient After Aortic Valve Replacement
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) has shown the ability to identify treatable causes of shock in patients after cardiac surgery.1,2 Unfortunately, the use of TEE in unstable patients after cardiac surgery is limited by the availability of trained echocardiographers, equipment and resource availability, and physician bias that a diagnosis can be established by other means. Some but not all of these limitations may be overcome through technologic innovation.Early Diagnosis of Superior Vena Cava Obstruction Facilitated by the Use of Cerebral Oximetry
OCCLUSION OR SIGNIFICANT narrowing of the superior vena cava (SVC) leading to SVC syndrome is an uncommon event after cardiac surgery. Unrecognized SVC syndrome may progress to catastrophic airway swelling and cerebral injury. This case describes the occurrence of cerebral venous hypertension and congestion as a consequence of SVC narrowing after an aortic valve replacement (AVR), mitral valve repair, and coronary artery bypass graft (CABG) surgery, which was rapidly recognized and subsequently repaired because of an acute bilateral significant decrease in cerebral oxygen saturation detected by cerebral oximetry (Invos 5100; Somanetics Corp, Troy, MI).CASE 1—2009 Retrocardiac Sponge-Induced Hemodynamic Instability After Cardiac Surgery
UNINTENTIONAL FOREIGN BODIES, like surgical sponges, left within the pericardial cavity during cardiac surgery may be associated with morbidity and mortality. A surgical sponge placed posterior to the heart may remain undetected and be the source of persistent hemodynamic instability. The authors report an incident wherein a surgical sponge placed posterior to the heart during cardiopulmonary bypass (CPB) was detected by intraoperative transesophageal echocardiography (TEE) to be the cause of unstable hemodynamics in the post-CPB period.
