Reparación de una disección de aurícula izquierda: presentación de un caso / Repair of left auricular dissection: case report

Resumen Introducción: La disección de la aurícula izquierda es una complicación infrecuente, pero potencialmente fatal de la cirugía cardíaca. Es frecuentemente asociada a cirugías de la válvula mitral, tanto su reparación el reemplazo, con una incidencia de 0,16%. Sin embargo, otros procedimientos como intervenciones percutáneas también presentan este riesgo. Objetivos: Presentar la resolución quirúrgica de un caso de disección de aurícula izquierda y aportar a la casuística nacional. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Una paciente que fue sometida a ablación por radiofrecuencia por vía retrógrada, y cursa durante el periodo postintervencional con insuficiencia cardíaca y su estudio identifica una disección auricular. Se realiza reparación del anillo mitral, plastía del aparato subvalvular y parche de pericardio, la paciente presenta evolución clínica y ecográfica favorable. Discusión: El tratamiento de esta entidad debe analizarse caso a caso, ya que la etiología relacionada a procedimientos percutáneos es diferente a la causada por cirugía valvular mitral. Conclusión: La reparación de una disección auricular con parche es una buena alternativa de tratamiento en estos casos.

Introduction: Left atrial dissection is an infrequent but potentially fatal complication of cardiac surgery. It is frequently associated with mitral valve surgery, both its repair and replacement, with an incidence of 0.16%. However, other procedures such as percutaneous interventions can also be predisposing factors. Objectives: To report the surgical resolution of a left atrial dissection case and contribute to the national casuistry. Materials and Method: Clinical, imaging and photographic record of the clinical episode. Results: A patient who underwent retrograde radiofrequency ablation during the post-interventional period with heart failure and whose study identifies an atrial dissection. Mitral ring repair, subvalvular apparatus repair and pericardial patch was performed, the patient evolves with favorable clinical and sonographic evolution. Discussion: The treatment of this entity should be analyzed case by case, the etiology related to percutaneous procedures is different to that caused by mitral valve surgery and this should be considered when choosing a therapeutic option. Conclusion: Repairing an atrial dissection with a patch is a good alternative in these cases.

Role of transesophageal echocardiography during left atrial appendage occlusion device closure in a patient with non-valvular atrial fibrillation and angiodysplasia of the colon

Atrial fibrillation is the most common arrhythmia associated with significant mortality and morbidity secondary to thrombo-embolism. To prevent this thrombo-embolism oral anticoagulation therapy is the recommended treatment. In patients with contraindications to oral anticoagulation therapy, percutaneous left atrial appendage occlusion device is indicated. TEE is essential to guide in all the stages of LAA device deployment. Right from pre-procedure screening, to guiding during deployment, to rule out any complications and post-procedure surveillance and monitoring long term outcomes.

Streptococcus sanguinis Endocarditis Involving All Valves in a Patient with Ventricular Septal Defect

No abstract available.

An update on transesophageal echocardiography views 2016: 2D versus 3D tee views.

In 1980, Transesophageal Echocardiography (TEE) first technology has introduced the standard of practice for most cardiac operating rooms to facilitate surgical decision making. Transoesophageal echocardiography as a diagnostic tool is now an integral part of intraoperative monitoring practice of cardiac anaesthesiology. Practice guidelines for perioperative transesophageal echocardiography are systematically developed recommendations that assist in the management of surgical patients, were developed by Indian Association of Cardiac Anaesthesiologists (IACTA). This update relates to the former IACTA practice guidelines published in 2013 and the ASE/EACTA guidelines of 2015. The current authors believe that the basic echocardiographer should be familiar with the technical skills for acquiring 28 cross sectional imaging planes. These 28 cross sections would provide also the format for digital acquisition and storage of a comprehensive TEE examination and adds 5 more additional views, introduced for different clinical scenarios in recent times. A comparison of 2D TEE views versus 3D TEE views is attempted for the first time in literature, in this manuscript. Since, cardiac anaesthesia variability exists in the precise anatomic orientation between the heart and the oesophagus in individual patients, an attempt has been made to provide specific criteria based on identifiable anatomic landmarks to improve the reproducibility and consistency of image acquisition for each of the standard cross sections.

Aortic root to left-atrial fistula after aortic valve replacement: A rare complication and its intraoperative management.

Aorto‑atrial fistula is a rare complication of prosthetic aortic valve replacement (AVR) and most of them have been diagnosed as a late complication. We present a case of this unusual complication after AVR. Intraoperative transoesophageal echocardiography identified and diagnosed this rare and potentially disastrous surgical complication and confirmed adequacy of its surgical repair.

Unique Congenital Malformation of the Mitral Valve Associated with Anomalous Coronary Arteries and Stroke

A 55-year-old male presented with stroke. Transesophageal echocardiogram and cardiac computed tomography revealed an unrecognized congenital malformation of the anterior mitral leaflet associated with anomalous left coronary circumflex artery, arising from the right coronary artery, diagnosed first by echocardiogram. This case represents a unique unforeseen mitral valve anomaly that might be considered as potential cardiac source of embolism. This finding broadens the spectrum of known mitral valve anomalies.

The analysis of the sensitivity and specificity by pulmonary artery catheter and transesophageal echocar-diography regarding volume responsiveness in cardiac surgery / 临床麻醉学杂志

Objective To analyze the sensitivity and specificity of several volume parameters regarding volume responsiveness.The studied volume parameters include pulmonary artery obstruc-tion pressure (PAOP),central venous pressure (CVP),right ventricular end-diastolic volume (RV-EDV)measured by Swan-Ganz pulmonary artery catheter and left ventricular end-diastolic area (LVEDA),inferior vena cava diameter (IVC)measured by transesophageal echocardiography (TEE). Methods Twelve patients with ASA Ⅱ or Ⅲ,scheduled for coronary artery bypass grafting were studied.After anesthesia induction,the TEE probe was put into the esophagus and Swan-Ganz cathe-ter was placed in right internal jugular venous.Measurements were made at the time before cutting the skin (T0 ),20 min after divorcing from cardiopulmonary bypass or finishing vascular anastomosis in off-pump surgery(T1 ),10 min after rapid infusion (T2 )and 30 min after rapid infusion (T3 ),re-spectively.Results The values of PAOP,IVC,LVEDA,COLVOT at time T2 increased significantly compared to those at time T1 (P <0.01).No obvious correlation (r=-0.298 5、r=-0.091 8、r=-0.243 6)was observed between △CVP、△PAOP、△RVEDV and △COLVOT (the difference between T2 and T1 );Meanwhile,△IVC and △LVEDA were well correlated to △COLVOT (r= 0.445 0、r=0.612 0).Using more than 1 5% change of COLVOT after volume expansion as definition of positive re-sponse,the areas under the receiver operating characteristic curves of CVP,PAOP,RVEDV,IVC and LVEDA were 0.389 (95% CI 0.035-0.743 ),0.458 (95% CI 0.109-0.807 ),0.333 (95% CI 0-0.671 ), 0.903 (95% CI 0.701-1.000 ) and 0.889 (95% CI 0.661-1.000 ), respectively. Conclusion PAOP,IVC,LVEDA,CO are more sensitive to the change of volume;while CVP and RVEDV have weak responses to volume changes.This indicates that IVC and RVEDA have more ad-vantage to estimate cardiac output increase and guide volume therapy.