Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Jan 2022
Observational StudyQuantification of Right Atrial-Indexed End-Systolic Volumes and Emptying Fraction in Children Undergoing Cardiac Surgery With Two-Dimensional Transesophageal Echocardiography: A Prospective Observational Study.
The primary objective of this study was to establish "normal" right atrial (RA)-indexed end-systolic volumes (ESVs) and emptying fraction (EF) in children undergoing ventricular septal defect (VSD) repair using two-dimensional (2D) transesophageal echocardiography (TEE). Secondary objectives were to obtain RA-indexed ESV and EF in children with RA/right ventricular (RV) volume overload (atrial septal defect [ASD]) and RV pressure overload (tetralogy of Fallot [TOF]) and to determine whether baseline differences existed in these indices among the three lesions. ⋯ This was the first study using 2D TEE to measure RA indices in children with and without right-sided heart dilation undergoing cardiac surgery. In this study, RA, ESV, and EF were considerably different in children with congenital heart disease causing RV pressure or volume overload. Additional studies can examine how these values can be used for risk stratification in this cohort of patients or how they correlate with measures of ventricular performances.
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J. Cardiothorac. Vasc. Anesth. · Jan 2022
Editorial CommentScore2: A New Updated Algorithm to Predict Cardiovascular Disease Risk in Europe.
The recently published guidelines of the European Society of Cardiology for the prevention of cardiovascular diseases presented in August 2021 at the virtual European Society of Cardiology congress recommend the use of the SCORE2 risk index instead of the classic SCORE risk index to calculate the cardiovascular risk (specifically, ten-year fatal and nonfatal risk) in a healthy population under the age of 70 years, with a level of evidence IB. This new risk index was developed with the collaboration of about 200 investigators, including 45 cohorts in 13 countries with 700,000 participants, and covers the known risk factors for heart and circulatory diseases such as age, sex, lipid levels, blood pressure, and smoking. In addition, it divides the countries into four groups of risk and uses a competing risk model, adjusting the risk for the probability of having another event, which enables better estimation of the risk of fatal and nonfatal events in a younger population (40-69 years).
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J. Cardiothorac. Vasc. Anesth. · Jan 2022
Case ReportsFactor V Deficiency (Owren's Disease) in a Patient at High Risk for Transfusion-Associated Circulatory Overload and Bleeding During Laser Lead Extraction.
Congenital factor V deficiency is an extremely rare abnormality and may be associated with significant bleeding as a result of trauma or surgery. Perioperative management primarily includes the administration of fresh frozen plasma to replace the deficient clotting factor. Acute administration of multiple blood products is a risk factor for transfusion-associated circulatory overload. Herein, the case of a 71-year-old man with an ejection fraction of 13% and a history of congenital factor V deficiency who was at risk for significant bleeding and transfusion-associated circulatory overload who underwent successful complex extraction of a right atrial pacing lead is reported.
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J. Cardiothorac. Vasc. Anesth. · Jan 2022
The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2020 Part I - Lung Transplantation.
This special article focuses on the highlights in cardiothoracic transplantation literature in the year 2020. Part I encompasses the recent literature on lung transplantation, including the advances in preoperative assessment and optimization, donor management, including the use of ex-vivo lung perfusion, recipient management, including those who have been infected with coronavirus disease 2019, updates on the perioperative management, including the use of extracorporeal membrane oxygenation, and long-term outcomes.
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J. Cardiothorac. Vasc. Anesth. · Jan 2022
Unilateral Pulmonary Edema After Robotically Assisted Mitral Valve Repair Requiring Veno-Venous Extracorporeal Membrane Oxygenation.
Unilateral pulmonary edema (UPE) is an uncommon yet potentially life-threatening complication of minimally invasive cardiac surgery (MICS). Most frequently described after robotically assisted mitral valve (MV) repair, it is characterized by right lung edema, hypoxemia, hypercapnia, pulmonary hypertension, and hemodynamic instability beginning minutes-to-hours after separation from cardiopulmonary bypass (CPB). The authors describe a severe case with refractory hypoxemia requiring veno-venous (VV) extracorporeal membrane oxygenation (ECMO) after robotically assisted MV repair.