Transesophageal echocardiography (TEE) is a relatively noninvasive and highly valuable diagnostic modality to monitor cardiac surgery. TEE is utilized to estimate the results of the surgical correction or the cardiac function on a real time basis. Accordingly, the frequency of TEE usage is increasing. Previous studies have shown low risk of TEE-associated complications; nonetheless, major gastrointestinal trauma can occur on a rare occasion. We herein present a case of Mallory-Weiss laceration after an intraoperative TEE examination.
Echocardiography, Transesophageal ; Humans ; Mallory-Weiss Syndrome ; Mitral Valve ; Organothiophosphorus Compounds ; Thoracic Surgery

With the growing number of patients undergoing left ventricular assist device (LVAD) implantation and improved survival in this population, more patients with LVADs are presenting for various types of non-cardiac surgery. Therefore, anesthesiologists need to understand the physiology and adequately prepare for the perioperative management of this unique patient population. This review addresses perioperative considerations and intraoperative management for the safe and successful management of patients with an LVAD undergoing non-cardiac surgery. Understanding the basic physiology of preload dependency and afterload sensitivity in these patients is essential. The main considerations include a collaborative preoperative multidisciplinary approach, perioperative care aimed at optimizing the intravascular volume and right ventricular function, and maintaining the afterload within recommended ranges for optimal LVAD function.

Redo cardiac operation is extremely hazardous because of adhesions of underlying structures between the sternum and the heart. Total body perfusion through femoral vessel cannulation in conjunction with endovascular aortic clamping can be achieved using remote access perfusion (RAP) endoclamp catheter prior to opening the sternum. We experienced a patient with Marfan syndrome who underwent redo Bentall operation. A 27-year-old male with Marfan syndrome who had undergone two previous Bentall operations was presented with infective endocarditis and pseudoaneurysm of aorta. Total cardiopulmonary bypass perfusion through RAP catheter before the sternotomy was initiated. Safe insertion and proper positioning of RAP catheter was guided by intraoperative transesophageal echocardiography. The operation was uneventful.
Adult ; Aneurysm, False ; Aorta ; Cardiopulmonary Bypass ; Catheterization ; Catheters* ; Constriction ; Echocardiography, Transesophageal ; Endocarditis ; Heart ; Humans ; Male ; Marfan Syndrome ; Perfusion* ; Reoperation* ; Sternotomy ; Sternum

Aortic dissection during pregnancy is a devastating event for both the pregnant woman and the baby. We report a case of acute aortic dissection (Stanford type A) in a pregnant woman with Marfan syndrome at the 29th week of gestation. She underwent a cesarean section followed by an ascending aorta and total arch replacement with cardiopulmonary bypass, without a prior sternotomy. The hemodynamic parameters were kept stable during the cesarean section by using inotropes and vasopressors under transesophageal echocardiography monitoring. The newborn survived after endotracheal intubation and management in a neonatal intensive care unit.
Aorta ; Cardiopulmonary Bypass ; Cesarean Section ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Hemodynamics ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Intubation, Intratracheal ; Marfan Syndrome* ; Pregnancy* ; Pregnant Women ; Sternotomy

This study was designed to determine whether early gabapentin treatment has a protective analgesic effect on neuropathic pain and compared its effect to the late treatment in a rat neuropathic model, and as the potential mechanism of protective action, the alpha2delta1-subunit of the voltage-dependent calcium channel (alpha2delta1-subunit) was evaluated in both sides of the L5 dorsal root ganglia (DRG). Neuropathic pain was induced in male Sprague-Dawley rats by a surgical ligation of left L5 nerve. For the early treatment group, rats were injected with gabapentin (100 mg/kg) intraperitoneally 15 min prior to surgery and then every 24 hr during postoperative day (POD) 1-4. For the late treatment group, the same dose of gabapentin was injected every 24 hr during POD 8-12. For the control group, L5 nerve was ligated but no gabapentin was administered. In the early treatment group, the development of allodynia was delayed up to POD 10, whereas allodynia was developed on POD 2 in the control and the late treatment group (p<0.05). The alpha2delta1-subunit was up-regulated in all groups, however, there was no difference in the level of the alpha2delta1-subunit among the three groups. These results suggest that early treatment with gabapentin offers some protection against neuropathic pain but it is unlikely that this action is mediated through modulation of the alpha2delta1-subunit in DRG.
Amines/administration & dosage/*therapeutic use ; Analgesics/administration & dosage/*therapeutic use ; Animals ; Calcium Channels/genetics/*metabolism ; Cyclohexanecarboxylic Acids/administration & dosage/*therapeutic use ; Disease Models, Animal ; Injections, Intraperitoneal ; Ligation ; Male ; Neuralgia/*drug therapy/metabolism ; Pain Measurement ; Protein Subunits/genetics/metabolism ; Rats ; Rats, Sprague-Dawley ; Spinal Nerves/surgery ; Up-Regulation ; gamma-Aminobutyric Acid/administration & dosage/*therapeutic use