Moderate Aortic Stenosis and Coronary Artery Bypass Grafting: Clinical Update for the Perioperative Echocardiographer.

Incidental aortic stenosis in the setting of coronary artery bypass surgery may be a perioperative challenge. The accurate assessment of the degree of aortic stenosis remains an important determinant. Although severe aortic stenosis is an indication for valve replacement, current guidelines advise a balanced approach to the management of moderate aortic stenosis in this setting. Multiple factors should be considered in a team discussion to balance risks versus benefits for the various management options in the given patient. The rapid progress in aortic valve technologies also offer alternatives for definitive management of moderate aortic stenosis in this setting that will likely become even safer in the near future.

Anesthetic management of patients with pulmonary hypertension.

Advances in the treatment of patients with chronic pulmonary hypertension have greatly improved their functional status and longevity, and increasing numbers of these complex patients are presenting for elective noncardiac surgery. In this communication we will briefly review the classification and pathophysiology of pulmonary hypertension, summarize outpatient pharmacotherapy approaches, and discuss the perioperative preparation and management of these complex patients. With an understanding of the underlying pathophysiology of the disease and pharmacology of these new therapies, combined with careful perioperative planning and care, these patients can safely undergo elective surgical procedures.