Charles Hearn

Educational program for intraoperative transesophageal echocardiography

A lthough both disciplines have cooperated for many years, cardiovascular anesthesiology and echocardiography have recently grown and merged in part. Intraoperative echocardiography has demonstrated its usefulness in many aspects of cardiovascular surgery, including valvular repair and replacement, myocardial function, aortic aneurysm repair, congenital heart disease, pericardial disease, complications of surgery, endocarditis, myocardial ischemia, and many others. Given the enlarging scope of cardiovascular surgery, echocardiography can address the compelling need for precise and accurate intraoperative diagnostic and monitoring capabilities. With the rapid development and clinical application of this technology, little attention has been focused on the necessary skills, training, and means of confirming competency for physicians performing intraoperative echocardiography. This article will not address all the questions surrounding this subject, but will explore some of the relevant issues regarding the training of physicians in intraoperative echocardiography and describe the training program developed for anesthesiologists at the Cleveland Clinic. We present our program in the hope of stimulating further discussion and research. The ultimate objective in developing an organized training program in intraoperative echocardiography is to enhance patient care at our institution through the proficient use of echocardiography in the operating arena by physicians from varying specialties and practice backgrounds.

Minimally invasive aortic valve surgery: Anesthetic considerations

T he surgical approach to aortic valve surgery has traditionally involved a median sternotomy with cannulation of the ascending aorta and right atrium for the conduct of cardiopulmonary bypass (CPB) (1). Concerns regarding hospital stay, cost containment, and managed care have prompted less invasive surgical approaches for coronary artery bypass surgery. Recently, a new approach to aortic valve surgery has been used to facilitate early tracheal extubation, ambulation, and hospital discharge. We present two cases that describe the surgical approach as well as perioperative complications and the anesthetic considerations for managing these patients.

Bleeding From a Pulmonary Artery Catheter Temperature Connection Port

p ERIOPERATIVE MONITORING with a balloon-tipped flow-directed pulmonary artery catheter (PAC) has been used clinically since 1970.1 The use of a PAC for cardiac surgical patients has become common practice, with low morbidity and mortality. However, significant complications during the insertion and use of this monitor include hematoma, 2 carotid artery puncture, 2 arrhythmias, 3,4 Homers syndrome, 5 pulmonary artery embolism or rupture, sepsis, pneumothorax, catheter knotting, or entrapment by sutures. 1,6-8 This report describes two unusual presentations of PAC entrapment by sutures not reported in the earlier literature.

A peril of minimally invasive surgery

A 23-YEAR-OLD woman presented with rheumatic mitral valve stenosis and regurgitation. She underwent a valvular commissurotomy and annuloplasty through a minimally invasive median sternotomy. Her operative course was unremarkable. However, after arrival in the intensive care unit, a postoperative chest radiograph showed an abnormality that required the patient to return to the operating room for rnediastinal reexploration. Identify the abnormality seen on the chest radiograph (Fig 1).

The Role of Transesophageal Echocardiography in Perfusion Management

Intraoperative transesophageal echocardiography (TEE) has been a valuable tool in cardiac surgery. The TEE probe can easily be inserted after endotracheal intuba tion to provide continuous monitoring and diagnosis during surgery. The role of TEE in the operating room is always expanding. This article examines the role of TEE specifically for cardiopulmonary bypass and perfusion management.