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Since its introduction into clinical practice in the early 1950s, the indications for CPB have broadened, from operations on or within the heart, to include non-cardiac thoracic, abdominal and neurological procedures. The indications for CPB for non-cardiac surgery are shown in Box 28.1.
The normal adult MV area is 4–6 cm2. Unlike other heart valves, the MV consists of two asymmetric leaflets. The aortic (anterior) leaflet makes up 65% of the valve area but its base forms only 35% of the circumference. The mural (posterior) leaflet usually consists of three main scallops, although there may be up to five. The leaflets are joined at the anterolateral and posteromedial ends of the commissure. The aortic MV leaflet shares the same fibrous attachment as the non-coronary cusp of the AV.
A comprehensive review of the complications of cardiac surgery would fill an entire volume. This chapter covers the more common and life-threatening complications. The reader is directed to the publications list under further reading.
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.