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Survey of the Clinical Assessment and Utility of Near-Infrared Cerebral Oximetry in Cardiac Surgery
Near-infrared cerebral oximetry increasingly is used for monitoring during cardiac surgery. Nonetheless, the scientific basis for incorporating this technology into clinical practice, the indications for when to do so, and standard diagnostic and treatment algorithms for defining abnormal values are yet to be rigorously defined. The authors hypothesized that there would be (1) variation in clinical use and practices for near-infrared spectroscopy (NIRS), and (2) variation in management of patients when clinicians are provided with NIRS information.Anesthetic Management of Robotically Assisted Totally Endoscopic Coronary Artery Bypass Surgery (TECAB)
TOTALLY ENDOSCOPIC coronary artery bypass (TECAB) performed with robotic technology is an innovative procedure that allows coronary revascularization in the closed chest. Experience with TECAB surgery first was reported in 1999,1 and subsequent results have demonstrated the general application of this technique.2-4 Early and midterm patient outcomes are comparable to the conventional approach,2-6 but these initial cohorts of patients are still under observation for long-term outcomes.Feasibility of Measuring Renal Blood Flow Using Transesophageal Echocardiography in Pediatric Patients Undergoing Cardiac Surgery
To evaluate the feasibility of measuring renal blood flow (RBF) using transesophageal echocardiography (TEE) in pediatric patients undergoing cardiac surgery.Robot-Assisted Mitral Valve Repair
BASED LARGELY ON THE success of laparoscopic surgery in the 1990s, minimally invasive surgical approaches have gained widespread acceptance among many surgical specialties; cardiac surgery is no exception. In addition, the lay press and Internet are replete with reports of cardiac valve repair or replacement through small incisions with reportedly improved recovery times and cosmesis. Perhaps the most dramatic change to the surgical approach of valvular repair is with the use of robotic assistance (Fig 1).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).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.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.
