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Temporary Epicardial Pacing After Cardiac Surgery
Temporary epicardial pacing frequently is employed after cardiac surgery, and can have a significant impact on a patient's hemodynamics, arrhythmias, and valvulopathies. Given that anesthesiologists often are involved intimately in the initial programming and subsequent management of epicardial pacing in the operating room and intensive care unit, it is important for practitioners to have a detailed understanding of the modes, modifiable intervals, and potential complications that can occur after cardiac surgery.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.Ultrasound-Enhancing Agent Enables Transthoracic Echocardiography in Patients With Delayed Sternal Closure
DELAYED STERNAL CLOSURE (DSC) is a technique adopted to manage unstable patients after cardiac surgery, including low-cardiac-output state (LCOS), intractable bleeding, and arrhythmia.1 This cohort of patients may have extensive devices within the thorax, including metal retractors, vacuum- assisted closure systems, swabs, drains, and central venoarterial extracorporeal membrane oxygenation (VA ECMO) cannulae, rendering cardiac visualization very challenging. Transesophageal echocardiography (TEE) is the main tool to assess cardiac function in these patients.Intraoperative and Early Postoperative Management of Patients Undergoing Minimally Invasive Left Ventricular Assist Device Implantation
Minimally invasive approaches for left ventricular assist device (LVAD) implantation have grown in popularity and have many potential advantages, including less bleeding, shorter recovery time, and improved postoperative right ventricular function compared with traditional implantation. Centrifugal flow LVADs are easily implanted via a minimally invasive approach. In this article, the authors review intraoperive considerations for minimally invasive LVAD implantation and hemodynamic management principles for patients with centrifugal flow LVADs.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.
