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1.
Artigo | IMSEAR | ID: sea-219281

RESUMO

Electroconvulsive therapy (ECT) is a safe and effective treatment for many psychiatric disorders. The passage of electrical current lead to hemodynamic alterations which may be detrimental to patients suffering from severe coronary artery disease. We describe perioperative anesthetic management of a patient having severe left main coronary artery stenosis (LMCAS) with severe triple vessel coronary artery disease (TVD).

4.
Ann Card Anaesth ; 2014 Jul; 17(3): 260-261
Artigo em Inglês | IMSEAR | ID: sea-153692
5.
Ann Card Anaesth ; 2014 Jul; 17(3): 211-221
Artigo em Inglês | IMSEAR | ID: sea-153674

RESUMO

Hypertrophic cardiomyopathy (HCM) poses many unique challenges regarding the conduct of anesthesia and surgery. Adequate preload, control of sympathetic stimulation, heart rate, and increased afterload are required to decrease the left ventricular outfl ow tract obstruction. Comprehensive intraoperative transesophageal echocardiography (TEE) examination confi rms the diagnosis, elucidates the pathophysiology, and identifi es the various anomalies of mitral valve apparatus and allows assessment of the adequacy of surgery. In this review, we focus on the preoperative assessment, conduct of anesthesia and comprehensive TEE examination of patients presenting for surgery with HCM. The various surgical options are extended myectomy and resection, plication and release.


Assuntos
Anestesia/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiomiopatia Hipertrófica/cirurgia , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Septos Cardíacos/cirurgia , Humanos
7.
Ann Card Anaesth ; 2014 Apr; 17(2): 118-124
Artigo em Inglês | IMSEAR | ID: sea-150309

RESUMO

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disease with many genotype and phenotype variations. Earlier terminologies, hypertrophic obstructive cardiomyopathy and idiopathic hypertrophic sub‑aortic stenosis are no longer used to describe this entity. Patients present with or without left ventricular outflow tract (LVOT) obstruction. Resting or provocative LVOT obstruction occurs in 70% of patients and is the most common cause of heart failure. The pathology and pathophysiology of HCM includes hypertrophy of the left ventricle with or without right ventricular hypertrophy, systolic anterior motion of mitral valve, dynamic and mechanical LVOT obstruction, mitral regurgitation, diastolic dysfunction, myocardial ischemia, and fibrosis. Thorough understanding of pathology and pathophysiology is important for anesthetic and surgical management.


Assuntos
Cardiomiopatia Hipertrófica/genética , Cardiomiopatia Hipertrófica/patologia , Cardiomiopatia Hipertrófica/fisiopatologia , Cardiomiopatia Hipertrófica/fisiologia , Humanos , Insuficiência da Valva Mitral , Sístole/fisiologia , Obstrução do Fluxo Ventricular Externo
9.
Ann Card Anaesth ; 2014 Jan; 17(1): 52-55
Artigo em Inglês | IMSEAR | ID: sea-149694

RESUMO

Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri‑operative management issues in a case of mitral valve replacement for acute severe MR following BMV.


Assuntos
Adulto , Anestesia Geral , Valvuloplastia com Balão/métodos , Emergências , Feminino , /métodos , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Isquemia Miocárdica/etiologia , Complicações Pós-Operatórias/métodos , Cardiopatia Reumática/complicações , Cardiopatia Reumática/cirurgia , Choque/fisiopatologia , Choque/terapia
19.
Ann Card Anaesth ; 2011 Sept; 14(3): 203-205
Artigo em Inglês | IMSEAR | ID: sea-139610

RESUMO

A patent ductus arteriosus (PDA) is often present in patients undergoing correction of congenital heart disease. It is well appreciated that during cardiopulmonary bypass (CPB), a PDA steals arterial inflow into pulmonary circulation, and may lead to systemic hypoperfusion, excessive pulmonary blood flow (PBF) and distention of the left heart. Therefore, PDA is preferably ligated before initiation of CPB. We describe acute decreases of arterial blood pressure and entropy score with the initiation of CPB and immediate increase in entropy score following the PDA ligation in a child undergoing intracardiac repair of ventricular septal defect and right ventricular infundibular stenosis. The observation strongly indicates that a PDA steals arterial inflow into pulmonary circulation and if the PDA is dissected and ligated on CPB or its ligation on CPB is delayed the cerebral perfusion is potentially compromised.


Assuntos
Ponte Cardiopulmonar , Circulação Cerebrovascular , Pré-Escolar , Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/cirurgia , Eletroencefalografia , Entropia , Humanos , Ligadura , Circulação Pulmonar
20.
Ann Card Anaesth ; 2011 May; 14(2): 111-114
Artigo em Inglês | IMSEAR | ID: sea-139583

RESUMO

Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.


Assuntos
Anestesia Geral , Aspergilose/cirurgia , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Hemodinâmica/fisiologia , Humanos , Cuidados Críticos , Pulmão/cirurgia , Pneumopatias Fúngicas/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Procedimentos Cirúrgicos Pulmonares/métodos , Choque/complicações , Toracotomia/efeitos adversos
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