Structural Heart Issues in Dextrocardia: Situs Type Matters.

Background: Patients who are diagnosed with dextrocardia, a rare congenital heart condition in which the heart points toward the right side of the chest, need their specific situs classification (eg, solitus, inversus, ambiguus) ascertained to optimize their care and outcomes. In this report, we discuss the perioperative anesthetic management of a patient presenting with dextrocardia. Case Report: A 44-year-old African American female with a history of hypertension, hyperlipidemia, gastroesophageal reflux disease, and diabetes mellitus type 2 was admitted for shortness of breath, dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. The patient had been diagnosed with dextrocardia in 2003 at an outside hospital and was asymptomatic prior to this presentation. Chest x-ray revealed bilateral perihilar vascular congestion with bibasilar atelectasis and suspected small bilateral pleural effusions consistent with new-onset congestive heart failure. Preoperative 2-dimensional transthoracic echocardiography revealed an ostium secundum-type atrial septal defect (ASD) with mild left-to-right atrial shunting. The patient's ASD was repaired using a pericardial patch. Conclusion: The anesthetic management of patients presenting with dextrocardia is complex. Preoperative cardiac transthoracic echocardiography can identify cardiac lesions or aberrant anatomy associated with dextrocardia. Proper placement of electrocardiogram electrodes is necessary to avoid false-positive results for perioperative ischemia. Central line access must be adjusted to anatomic variations. Clinicians should have high suspicion for associated pulmonary hypertension and should limit sedatives preoperatively to minimize the cardiovascular effects of hypoxia and/or hypercarbia on the pulmonary vasculature. Finally, high clinical suspicion for respiratory complications should be maintained, as dextrocardia has been associated with respiratory complications secondary to primary ciliary dyskinesia in approximately 25% of patients.

A case study in Hansen's disease acquired after heart transplant.

Hansen's disease, leprosy, is a chronic infectious disease caused by the acid-fast bacillus Mycobacterium leprae. There are multiple forms of the disease ranging from the relatively benign to the progressive, malignant lepromatous leprosy. There is effective antimicrobial treatment available that is capable of curing the disease. We report the case of a post heart transplant patient acquiring Hansen's disease.

Osteoporosis: The dynamic relationship between magnesium and bone mineral density in the heart transplant patient.

Osteoporosis is a common, and potentially severe, complication seen in the heart transplant recipient. Frequently there is loss of bone mineral density prior to transplant that begins the downward spiral to fractures of the femoral neck and vertebrae. Multiple factors are responsible for the development of osteoporosis posttransplant. These factors include pretransplant bone mineral loss, use of corticosteroids and cyclosporine posttransplant, and development of persistent hypomagnesemia posttransplant. This article explores the relationship of serum magnesium levels to maintenance of bone mineral density.

Depression and anxiety in the heart transplant patient: a case study.

Depression and anxiety are potential psychological problems that a heart transplant patient may face both before and after transplant. In addition, there is the potential for difficulty in adjusting to life after transplantation. Anxiety and depression and their effects, both pretransplant and posttransplant, are explored. A case study is used to illustrate the psychological effects of trans plantation.

The management of immunosuppression: the art and the science.

The optimal use of immunosuppressant drugs requires an understanding of their mechanism of action as well as a basic understanding of the biology of transplant rejection and tolerance. The ability to tailor a drug regimen that strikes a fine balance between allograft maintenance and patient well-being demands a sensitivity to the patient's needs and expectations as well. The object of this article is to cover the basic biological principles involved in selecting an immunosuppressant protocol while sharing our experiences with these various regimen.

Outcomes of coronary artery bypass grafting in patients with a history of illicit drug use.

To date, no studies have been conducted on the effects of illicit drug use in patients with ischemic heart disease treated with coronary artery bypass grafting. Our retrospective study suggests that current illicit drug use is a significant predictor of cardiovascular complications in the first 6 months after coronary artery bypass grafting.