- 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.
- To characterize existing practice patterns for intraoperative evaluation and grading of diastolic dysfunction in patients undergoing cardiac surgery.
- To evaluate the feasibility of measuring renal blood flow (RBF) using transesophageal echocardiography (TEE) in pediatric patients undergoing cardiac surgery.
- 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.
- 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.
- 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.
- 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.