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2.
Tex Heart Inst J ; 49(6)2022 11 01.
Article in English | MEDLINE | ID: mdl-36534113

ABSTRACT

Coronary artery spasm constitutes the primary underlying pathology of variant angina. Because provocation of coronary artery spasm may occur with both excess sympathetic and excess parasympathetic stimulation, patients with this disorder have extremely limited options for perioperative pain control. This is especially true for procedures involving extensive abdominal incision/manipulation. Whereas neuraxial analgesia might otherwise be appropriate in these cases, several studies have demonstrated that coronary artery spasm can occur as a result of epidural placement, and therefore, that this may not be an optimal choice for patients with variant angina. This report discusses the case of a patient with a preexisting diagnosis of variant angina who underwent an exploratory laparotomy with large ventral hernia repair and for whom continuous erector spinae plane blocks were successfully used as analgesic adjuncts without triggering coronary artery spasm.


Subject(s)
Angina Pectoris, Variant , Coronary Vasospasm , Hernia, Ventral , Nerve Block , Humans , Angina Pectoris, Variant/diagnosis
3.
J Cardiothorac Vasc Anesth ; 33(10): 2866-2869, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31072708

ABSTRACT

Early onset prosthetic valve stenosis is an uncommon complication after valve replacement surgery and is often caused by thrombus formation. Frequently it can be diagnosed by echocardiography and managed with optimizing anticoagulation and/or thrombolysis. We review a unique case of early bi-leaflet mechanical heart valve (BMHV) dysfunction where the patient rapidly progressed to cardiogenic shock requiring emergent re-do mitral valve surgery. Intraoperatively, the valve leaflets were found to be almost completely immobile secondary to thrombus formation directly on the hinges of the valve. This case demonstrates how the leaflet orientation of a BMHV affects transmitral flow and fluid dynamics. Furthermore, we also discuss left atrial vortex formation in the setting of atrial fibrillation, kinetic energy transfer through an anatomically implanted mechanical mitral valve, and their roles in contributing to early prosthetic valve thrombosis despite adequate anticoagulation.


Subject(s)
Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis/adverse effects , Mitral Valve/surgery , Prosthesis Failure/etiology , Shock, Cardiogenic/etiology , Echocardiography, Transesophageal , Emergencies , Fatal Outcome , Female , Heart Valve Diseases/etiology , Humans , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve Stenosis/surgery , Reoperation/methods , Thrombosis/etiology
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