Diffuse Coronary Vasospasm After Mitral Valve Replacement, Maze Procedure, and Tricuspid Valve Repair.

Coronary vasospasm is a known complication after coronary artery bypass grafting surgery but has rarely been described in non-coronary cardiac operations. We report the case of a 51-year-old male with nonischemic cardiomyopathy and paroxysmal atrial fibrillation. He presented with severe mitral and tricuspid regurgitation and was taken for mitral valve replacement, tricuspid valve repair, and Maze procedure. Postoperative emergent coronary angiography demonstrated diffuse coronary vasospasm. Injection of intracoronary nitroglycerin led to clinical and angiographic improvement. This demonstrates the possibility of coronary vasospasm following mitral valve replacement and effective treatment with intracoronary administration of vasodilating agents.

Iatrogenic Aortic Intramural Hematoma: Guidance to Intraoperative Decision Making: A Case Report.

Aortic intramural hematoma (IMH) is a collection of blood within the aortic wall without an identifiable intimal tear. It belongs to the spectrum of acute aortic syndrome (AAS) which also includes aortic dissection (AD), a well-defined entity. Principles of management guided by Stanford classification is similar in both entities. But with recent advances in imaging, certain features of IMH have been identified that affect the natural course of IMH. We report a unique case of iatrogenic IMH complicating a routine coronary artery bypass graft surgery (CABG) and how imaging guided intraoperative decision making toward conservative management.

The patient simulator for training of anesthesia residents in the management of one lung ventilation.

Simulators are used extensively for the training of medical personnel. All anesthesia providers should be prepared and trained in the management of one lung ventilation for pulmonary surgery, yet familiarization with one lung ventilation may not be possible on a routine basis in the operating room. Therefore, this reports details the first use of the patient simulator (PS) to enhance the training of anesthesia residents in the management of one lung ventilation. A detailed report of our computer program for simulating one lung ventilation is included.

Integrating echocardiography into human patient simulator training of anesthesiology residents using a severe pulmonary embolism scenario.

INTRODUCTION: Echocardiographic images were integrated into patient simulation (PS)-based resident training with a goal of highlighting the applicability and limitations of pure pressure-based measurements in the management of different disease states. METHODS: Relevant echocardiographic images were selected, categorized, and sequenced to best represent specific hemodynamic changes and incorporated into a Powerpoint slideshow. Appropriate PS scenarios were then created to represent the hemodynamic changes seen with the selected pathophysiologic states. Instructors then displayed the visual images along with PS scenarios during lecture and testing sessions at the PS bedside during standard didactic sessions with small groups of anesthesiology residents and informal resident testing sessions. CONCLUSIONS: The use of echo images to demonstrate, in real time, the hemodynamic consequences of changes in myocardial contractility, cardiac chamber volume, and valvular function is possible during PS in anesthesiology residency training. Echo imaging as a teaching tool during anesthesiology residency may yield a greater understanding of the pathophysiology of certain disease states, ultimately leading to faster diagnosis and more appropriate intervention by anesthesiologists.