John D. Wasnick

Late cardiac perforation following transcatheter atrial septal defect closure

Transcatheter closure of secundum atrial septal defect (ASD) has become an alternative to surgery. We present a patient with hemodynamic collapse secondary to cardiac perforation occurring 6-months after the placement of an Amplatzer Septal Occluder and discuss the utilization/complications of this device.

The postoperative cardiovascular arrest of a 5-year-old male: an initial presentation of Duchenne's muscular dystrophy.

Anesthesia may be administered to patients with Duchennes muscular dystrophy, but cases are reported in which apparently healthy children suffer hyperkalemic cardiac arrest. We present the case of a 5‐year‐old boy whose muscular dystrophy was discovered following a fatal, perioperative cardiac arrest in the postanesthesia care unit.

Anesthesia and minimally invasive thoracoscopically assisted coronary artery bypass : A brief clinical report

OBJECTIVE To examine the anesthesia implications of minimally invasive thoracoscopically assisted coronary artery bypass (MITACAB) surgery. DESIGN A combined retrospective and prospective observational report of patients undergoing MITACAB surgery. SETTING A community heart center. PARTICIPANTS Patients having MITACAB surgery. INTERVENTIONS None specifically related to the report. MAIN RESULTS The MITACAB approach was found to be successful in completing left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) bypass in 17 of 20 patients. No patient required emergency institution of cardiopulmonary bypass or defibrillation during the procedure. However, 6 of the 17 patients who underwent the MITACAB surgery required transvenous pacing at the time of surgery. None of 17 patients who underwent MITACAB surgery has required additional cardiovascular intervention since the time of surgery. Stroke volume and pulmonary arterial pressures were generally unaffected during performance of the bypass graft. CONCLUSION MITACAB requires special anesthetic interventions; however, MITACAB appears to be a safe, effective approach to LIMA-to-LAD bypass.

Anesthetic management of staged separation of craniopagus conjoined twins.

We present a case of successful separation of craniopagus conjoined twins. The procedure was staged to permit each child to develop adequate independent cerebral venous drainage and to prevent deleterious, perioperative cerebral edema. Surgical hemorrhage, blood product delivery, and hemodilution were minimized.