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Pulmonary vascular surgery comprises emergency procedures such as pulmonary embolectomy and post-traumatic repair, and elective procedures such as palliation of PHT, pulmonary thromboendarterectomy (PTE), tumour resection and the Ross procedure. The focus of this chapter will be PHT and the management of patients undergoing PTE.
Ventricular dysfunction is associated with increased cardiovascular morbidity and mortality after both cardiac and non-cardiac surgery. Traditionally, invasive pressure monitoring has been used to make inferences regarding ventricular function. However, the relationship between pressure and organ perfusion may be affected by many variables in the dynamic intraoperative environment. TOE has the advantage of real-time visualization of ventricular filling, contractility and ischaemia. As such, TOE is now considered to be the ‘gold standard’ intraoperative monitor of ventricular function.
TTE evaluation of the heart valves requires both quantification of the severity of the pathology and identification of the underlying mechanism. This information will determine if surgical intervention is warranted and will guide the surgical decision as whether to repair or replace the diseased valve.
This fully-updated third edition provides a practical and concise guide to all aspects of the perioperative care of cardiac surgical patients. Produced by recognised leaders from world-renowned cardiac centres, this is the authoritative text for residents and fellows in anaesthesia and cardiac surgery, clinical perfusionists, and critical care nurses. Updated chapters include regional anesthesia, paediatric cardiac anaesthesia, and anaesthesia for specific procedures such as aortic valve surgery and cardiac transplantation. An entire section is dedicated to transoesophageal echocardiography (TOE) in recognition of the increasing demand for basic TOE training. The book also includes an expanded chapter on the applications and anaesthetic implications of extracorporeal membrane oxygenation (ECMO). The text focuses on clinical practice and the basic science and pharmacology underpinning cardiac anaesthesia, ensuring the reader can easily apply the knowledge gained to real-life situations.
An ASD is a common congenital cardiac lesion, comprising 6–10% of such anomalies at birth, although diagnosis may not occur until adulthood. The lesion may present as an atrial arrhythmia, paradoxical embolic stroke or exercise limitation secondary to RV volume overload. ASDs may be single or multiple and are associated with additional cardiac lesions in 30% of cases.