Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3781_Библиотеки_им_академика_М_И_Перельмана
.pdf
35 Principles ofPostoperative Care
https://t.me/medicina_free
403
Complications After Cardiac Surgery
Postoperative Bleeding [6, 26–28]
• Excessive postoperative bleeding is associated with increased blood transfusions, hospital length of stay, and cost. Postoperative hemorrhage occurs in
approximately 2–6% of cardiac surgery patients. Management of postoperative
bleeding starts before even leaving the OR.Utilization of a checklist to ensure
common areas of bleeding are checked and treated prior to closing has been
associated with reduced rates of re-exploration. Often, time will be spent in the
OR after the chest is closed monitoring chest tube output to identify patients who
require surgical interventions to obtain hemostasis.
• An important focus in the immediate postoperative period is maintaining chest
tube patency. If the chest tubes become clogged with clotted blood, this can lead
to cardiac tamponade or clinically signicant hemothorax, which can require
invasive interventions.
• Close monitoring for coagulopathy and thrombocytopenia is critical in cardiac
surgery patients as is treatment with transfusions to correct these abnormalities.
Treating hypothermia can also help to reverse coagulopathy. Anti-brinolytic
agents, like epsilon-aminocaproic acid (Amicar) and tranexamic acid (TXA),
have been found to be associated with reduced transfusion requirements in cardiac surgery patients without signicant increase in morbidity. Red blood cell
transfusions can replace blood loss while providing time for correction of
coagulopathies.
• If the above interventions are not successful in reducing blood loss, re- exploration
and washout in the OR are denitive treatments for postoperative blood loss.
Tamponade [2, 3, 6, 29–31]
• Cardiac tamponade occurs when the chambers of the heart become compressed
by external forces, often uid or blood. This leads to an equalization of pressures
between the four chambers and reduced venous lling. This reduces end diastolic volume and subsequently cardiac output. Tamponade can occur in the cardiac surgery patient when there is bleeding without sufcient drainage. This is
often signaled by tachycardia, narrowed pulse pressure, increased CVP, and
reduced cardiac output. Pulsus paradoxus can also been seen. Pulsus paradoxus
is a reduction in systolic blood pressure greater than 10mmHg during inspiration. Tamponade is also associated with increased vasopressor requirement and
worsening markers of perfusion.
• In non-surgical patients, TTE is often utilized to be the gold standard of diagnosis for cardiac tamponade. However, TEE has a greater ability to visualize pericardial uid/blood in patients after cardiac surgery. This is because TTE can be
404
https://t.me/medicina_free
limited by chest tubes, patient position, incision, and ventilation. Further, TEE
also allows for visualization of the posterior pericardium, where uid or clot may
have accumulated.
• Echocardiographic evidence of cardiac tamponade includes collapse of the atria
during systole or ventricles during diastole, respiratory variation of mitral and
tricuspid ow, and enlargement of the inferior vena cava with reduced pulsatility.
A chest X-ray can show an enlarged cardiac silhouette, and EKG can show low
voltage. However, classic signs of tamponade after cardiac surgery may not be
initially present so tamponade should be suspected in patients with hemodynamic instability and a pericardial collection.
• Maintaining chest tube patency is critical in the postoperative period to prevent
the accumulation of blood around the heart. Additionally, avoiding signicant
coagulopathy can reduce bleeding postoperatively. In the immediate postoperative period, a denitive measure to treat tamponade is re-exploration in the OR,
including opening of the chest and washout with identication and treatment of
any areas of bleeding. In decompensating patients, the chest can be opened at the
bedside. In patients who are several days from surgery, pericardial drain placement can relieve tamponade.
L. Franko and K. Shelton
Atrial Fibrillation [2, 5, 6, 32–34]
• Atrial brillation is common after cardiac surgery. Rates of atrial brillation are
between 10 and 50% after cardiac surgery, depending on the patient population
and surgery. High rates of atrial brillation are associated with increased age,
mitral valve disease, COPD, and valve surgery. Of note, medications likely epinephrine and norepinephrine can increase the risk of atrial brillation because of
sympathetic stimulation. Atrial brillation in the postoperative period is associated with signicant morbidity and increased length of stay.
• Beta blockers have been utilized at some institutions prophylactically to prevent
postoperative atrial brillation. Amiodarone has also been used prophylactically,
but often second line at many institutions due to possible toxicities and adverse
effects.
• Pericardial effusions have been associated with increased rates of atrial brillation, thought to be due to the effusion causing local inammation and oxidative
damage. Posterior left pericardiotomy has been shown to reduce rates of atrial
brillation without increasing complications. This procedure involves an incision in the posterior pericardium that allows postoperative pericardial uid to
drain into the left pleural space.
• The decision to anticoagulant postoperative patients with atrial brillation is
somewhat controversial though most patients with persistent atrial brillation
and higher CHA2DS2 VASc score are recommended to start on anticoagulation.
35 Principles ofPostoperative Care
https://t.me/medicina_free
405
Stroke [6, 35, 36]
• The overall risk of stroke with neurological decits after cardiac surgery is
approximately 2–3%. The risk of stroke is associated with increased age, diabetes, known preoperative cerebrovascular disease, and emergent operations. The
risk of stroke is highest in aortic and mitral valve surgery. Stroke is associated
with increased morbidity and mortality after cardiac surgery.
References
1. Chatterjee S, Shake JG, Arora RC, Engelman DT, Firstenberg MS, Geller CM, etal. Handoffs
from the operating room to the intensive care unit after cardiothoracic surgery: from the Society
of Thoracic Surgeons Workforce on Critical Care. Ann Thorac Surg. 2019;107(2):619–30.
2. Stephens RS, Whitman GJ.Postoperative critical care of the adult cardiac surgical patient. Part
I: routine postoperative care. Crit Care Med. 2015;43(7):1477–97.
3. Cohn LH, Adams DH.Cardiac surgery in the adult. 5th ed. McGraw-Hill Education; 2017.
4. Annich G, Lynch W, Maclaren G, Wilson J, Bartlett R, editors. ECMO: extracorporeal cardiopulmonary support in critical care. 4th ed. Ann Arbor: Extracorporeal Life Support
Organization; 2012.
5. DiMarco RF Jr. Postoperative care of the cardiac surgical patient. In: Surgical intensive care
medicine. Boston: Springer; 2010. p.535–66.
6. Stephens RS, Whitman GJ.Postoperative critical care of the adult cardiac surgical patient:
part II: procedure-specic considerations, management of complications, and quality improvement. Crit Care Med. 2015;43(9):1995–2014.
7. Tomita A, Takada S, Fujimoto T, Iwasaki M, Hayashi Y.Analysis of difculty in placement
of pulmonary artery catheter through the left internal jugular vein. JA Clin Rep. 2020;6(1):63.
8. Hadian M, Pinsky MR.Evidence-based review of the use of the pulmonary artery catheter:
impact data and complications. Crit Care. 2006;10(3):S8.
9. Neerukonda T, Gibson WJ, Abicht T, Sauer A, Flynn BC.Pulmonary artery rupture management with a single lumen endotracheal tube: old tricks that should be revisited. Am J Case
Rep. 2018;19:342–6.
10. Johnston LE, Thiele RH, Hawkins RB, Downs EA, Jaeger JM, Brooks C, etal. Goal-directed
resuscitation following cardiac surgery reduces acute kidney injury: a quality initiative prepost analysis. J Thorac Cardiovasc Surg. 2020;159(5):1868–77.e1.
11. Yelderman ML, Ramsay MA, Quinn MD, Paulsen AW, McKown RC, Gillman PH.Continuous
thermodilution cardiac output measurement in intensive care unit patients. J Cardiothorac Vasc
Anesth. 1992;6(3):270–4.
12. Reade MC.Temporary epicardial pacing after cardiac surgery: a practical review: part 1: general considerations in the management of epicardial pacing. Anaesthesia. 2007;62(3):264–71.
13. Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, et al. The 2013
International Society for Heart and Lung Transplantation guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant. 2013;32(2):157–87.
14. Klijian A, Khanna AK, Reddy VS, Friedman B, Ortoleva J, Evans AS, et al. Treatment
with angiotensin II is associated with rapid blood pressure response and vasopressor sparing in patients with vasoplegia after cardiac surgery: a post-hoc analysis of angiotensin
II for the treatment of high-output shock (ATHOS-3) study. J Cardiothorac Vasc Anesth.
2021;35(1):51–8.
15. Bojar R.Manual of perioperative care in adult cardiac surgery. 5th ed. Wiley-Blackwell; 2011.
406
https://t.me/medicina_free
16. Overgaard CB, Dzavík V.Inotropes and vasopressors: review of physiology and clinical use in
cardiovascular disease. Circulation. 2008;118(10):1047–56.
17. Totaro RJ, Raper RF.Epinephrine-induced lactic acidosis following cardiopulmonary bypass.
Crit Care Med. 1997;25(10):1693–9.
18. Devereaux PJ, Lamy A, Chan MTV, Allard RV, Lomivorotov VV, Landoni G, et al.
High-sensitivity troponin I after cardiac surgery and 30-day mortality. N Engl J Med.
2022;386(9):827–36.
19. Tolsma M, Kröner A, van den Hombergh CL, Rosseel PM, Rijpstra TA, Dijkstra HA, etal. The
clinical value of routine chest radiographs in the rst 24 h after cardiac surgery. Anesth Analg.
2011;112(1):139–42.
20. Mwaura L, Vuylsteke A.Fueling the debate on albumin after cardiac surgery. J Cardiothorac
Vasc Anesth. 2019;33(11):2928–9.
21. Kim JH, Kim HJ, Kim JY, Ahn H, Ahn IM, Choe WJ, etal. Meta-analysis of sodium bicarbonate therapy for prevention of cardiac surgery-associated acute kidney injury. J Cardiothorac
Vasc Anesth. 2015;29(5):1248–56.
22. Haase M, Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, etal. Sodium bicarbonate to prevent increases in serum creatinine after cardiac surgery: a pilot double-blind,
randomized controlled trial. Crit Care Med. 2009;37(1):39–47.
23. Tie HT, Luo MZ, Luo MJ, Zhang M, Wu QC, Wan JY.Sodium bicarbonate in the prevention
of cardiac surgery-associated acute kidney injury: a systematic review and meta-analysis. Crit
Care. 2014;18(5):517.
24. Chan JL, Miller JG, Murphy M, Greenberg A, Iraola M, Horvath KA.A multidisciplinary
protocol-driven approach to improve extubation times after cardiac surgery. Ann Thorac Surg.
2018;105(6):1684–90.
25. Fitch ZW, Debesa O, Ohkuma R, Duquaine D, Steppan J, Schneider EB, etal. A protocoldriven approach to early extubation after heart surgery. J Thorac Cardiovasc Surg.
2014;147(4):1344–50.
26. Elassal AA, Al-Ebrahim KE, Debis RS, Ragab ES, Faden MS, Fatani MA, etal. Re-exploration
for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate. J
Cardiothorac Surg. 2021;16(1):166.
27. Christensen MC, Dziewior F, Kempel A, von Heymann C.Increased chest tube drainage is
independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc
Anesth. 2012;26(1):46–51.
28. Gerstein NS, Brierley JK, Windsor J, Panikkath PV, Ram H, Gelfenbeyn KM, et al.
Antibrinolytic agents in cardiac and noncardiac surgery: a comprehensive overview and
update. J Cardiothorac Vasc Anesth. 2017;31(6):2183–205.
29. Imren Y, Tasoglu I, Oktar GL, Benson A, Naseem T, Cheema FH, etal. The importance of
transesophageal echocardiography in diagnosis of pericardial tamponade after cardiac surgery.
J Card Surg. 2008;23(5):450–3.
30. Price S, Prout J, Jaggar SI, Gibson DG, Pepper JR. ‘Tamponade’ following cardiac surgery: terminology and echocardiography may both mislead. Eur J Cardiothorac Surg.
2004;26(6):1156–60.
31. Carmona P, Mateo E, Casanovas I, Peña JJ, Llagunes J, Aguar F, etal. Management of cardiac
tamponade after cardiac surgery. J Cardiothorac Vasc Anesth. 2012;26(2):302–11.
32. Boons J, Van Biesen S, Fivez T, de Velde MV, Al Tmimi L.Mechanisms, prevention, and treatment of atrial brillation after cardiac surgery: a narrative review. J Cardiothorac Vasc Anesth.
2021;35(11):3394–403.
33. Gaudino M, Sanna T, Ballman KV, Robinson NB, Hameed I, Audisio K, etal. Posterior left
pericardiotomy for the prevention of atrial brillation after cardiac surgery: an adaptive,
single- centre, single-blind, randomised, controlled trial. Lancet. 2021;398(10316):2075–83.
34. Arsenault KA, Yusuf AM, Crystal E, Healey JS, Morillo CA, Nair GM, etal. Interventions
for preventing post-operative atrial brillation in patients undergoing heart surgery. Cochrane
Database Syst Rev. 2013;2013(1):Cd003611.
L. Franko and K. Shelton
35 Principles ofPostoperative Care
https://t.me/medicina_free
35. Sultan I, Bianco V, Kilic A, Jovin T, Jadhav A, Jankowitz B, etal. Predictors and outcomes of
ischemic stroke after cardiac surgery. Ann Thorac Surg. 2020;110(2):448–56.
36. Karunanantham J, Ali JM, Evans NR, Webb S, Large SR.Impact of stroke on outcomes following cardiac surgery: propensity matched analysis. J Card Surg. 2020;35(11):3010–6.
407
Index
https://t.me/medicina_free
A
Abdominal aortic trauma
initial evaluation, 264
mechanism of, 263
Abdominal vascular trauma, 266
Aberrant right subclavian artery, 23
Activated clotting time (ACT), 105, 111
Acute aortic syndrome (AAS), 78, 79
anatomy and classication, 248
cannulation strategy, 254
axillary, right subclavian, innominate,
and other arch branch arterial
cannulation, 255
direct aortic, 255
femoral, 254
denition, 247, 248
diagnosis, 251, 252
indications for surgery
ascending aorta, 252, 253
descending aorta, 254
outcome, 247, 248
pathophysiology and clinical presentation,
250, 251
Acute coronary syndromes, 124
Acute mitral regurgitation
diagnosis, 135
management, 136
pathogenesis, 135
Acute mitral regurgitation (AMR), 133
Acute myocardial infarction, 134
Acute normovolemic hemodilution
(ANH), 104
Acute pericarditis, 291–293, 295
Acute pulmonary embolism (PE), 275
indications for surgery, 278
operative techniques for pulmonary
embolectomy, 278, 279
presentation and diagnosis, 276
risk stratication, 277, 278
treatment, 277
Acute type A aortic dissection (ATAAD), 248
Adult coarctation of the aorta (CoA), 375–378
Adults with congenital heart disease
(ACHD), 365
adult coarctation of the aorta, 375–378
complex, 381–384
cor triatriatum dexter, 379–381
coronary artery anomalies, 369–370
Tetralogy of Fallot, 367–369
vascular ring, 371–374
Afterload, 394
Alcohol septal ablation, 311
Alpha-stat, 114
American Society of Anesthesiologists (ASA)
Monitoring, 93
Anemia, 105
preoperative treatment of
nonpharmacologic intervention, 100
pharmacologic intervention, 100
Anesthesia
cardiopulmonary bypass, 97, 98
hemodynamic and physiologic monitoring
advanced hemodynamic monitoring, 94
Standard American Society of
Anesthesiologists Monitoring, 93
lesion specic considerations, 95, 96
pharmacology of induction and
maintenance, 94, 95
pulmonary artery catheter, 97
vasoactive medications, 96
Springer Nature Switzerland AG 2024
J. P. Bloom, T. M. Sundt (eds.), Cardiac Surgery Clerkship, Contemporary
Surgical Clerkships, https://doi.org/10.1007/978-3-031-41301-8
409© The Editor(s) (if applicable) and The Author(s), under exclusive license to
410
https://t.me/medicina_free
Index
Anesthesia team, 388, 393
Aneurysm, 67, 76, 229
Aneurysm repair, 218
Angiography, 234
Angiosarcomas, 303
Annular dilation, 167
Annuloplasty, 158, 159
Antegrade cannulation, 121
Antegrade cardioplegia, 120
Antegrade cerebral perfusion (ACP), 115
Anterior interventricular groove, 15
Anterolateral papillary muscle, 21
Anticoagulant management, 100, 101
Anticoagulation via heparin, 111
Antiplatelet management, 101
Aorta, 22, 23, 76
imaging ndings
acute aortic syndrome, 78, 79
aneurysm, 76
coarctation, 80
double rule-out, 81
pre-procedural CT, 80, 81
indications, 76
volume-rendered reconstruction, 81
Aortic aneurysm formation, 217
Aortic arch, 216, 223, 255
surgery, 221–223
variants, 23
Aortic cross-clamp, 359
Aortic diameter, 231
Aortic dissection (AD), 247, 248
classication, 248
diagnosis, 251, 252
pathophysiology and clinical presentation,
250, 251
Aortic insufciency (AI), 192, 342
Aortic lesions, 96
Aortic pseudoaneurysm, 79
Aortic regurgitation (AR), 52, 53, 144
Aortic root
anatomy, 215
etiology and dilation, 217
surgery, 218–220
Aortic root replacement, 8
Aortic stenosis (AS), 52, 143, 144
Aortic trauma
abdominal aortic trauma
initial evaluation, 264
mechanism of, 263
indications for intervention, 265–267
mechanism of, 262
operative approach, 267–272
thoracic aortic trauma
initial evaluation, 263, 264
mechanism of, 262
Aortic valve, 22
Aortic valve annulus, 215
Aortic valve bioprosthetic failure, 192
Aortic valve disease, 192
Aortic valve repair, 378
indications, 144, 145
of bicuspid aortic valve with R-L
fusion, 146
techniques, 145
Aortic valve replacement, 378
indications, 144, 145
mechanical valves, 147
Ozaki procedure, 147
paravalvular regurgitation, 148
prosthesis selection, 148
Ross procedure, 147
small aortic roots, 148
stented bioprosthetic valves, 146
stentless valves, 147
Aortomitral curtain, 19
Arrhythmias, 301
Arrhythmogenic right ventricular
cardiomyopathy, 347
Arrythmias, 156
Arteria lusoria, 23
Arterial cannulation, 255
Arterial line, 94
Arterial reconstruction, 241
Articial chordae, 172
Articial heart, 10
Articial shunt, 2
Ascending aorta, 215, 252, 253
Ascending aorta replacement, 378
Atrial brillation
(AF), 283, 285, 286, 404
classication, 284
LAA management, 287
surgical treatment options
Cox-Maze, 284–286
PVI, 286
Atrial septal defect (ASD), 3, 195
Atrial tumors, 301
Atrioventricular (AV) node, 24
Atrioventricular groove, 15
Atrioventricular node, 20
Atrioventricular septal defect (AVSD) repair,
173, 174
Autoimmune disorders, 229
Autologous pericardium, 157
Index
https://t.me/medicina_free
411
B
Bachmann’s bundle, 25
Bacterial endocarditis, 218
Bare mental stents (BMS), 88
Barlow’s disease, 153
Basic metabolic panel (BMP), 33
Basiliximab, 352
Benzodiazepines, 94
Beta blockers, 404
Bicaval cannulation, 111, 340
Bicaval venous cannulation, 222
Bicuspid aortic valve (BAV) stenosis, 202
Bicuspid aortic valves, 143, 145
Bicuspidization, 172
Bioprosthetic mitral valve replacement
(MVR), 160, 161
Biventricular assist devices
(BiVADs), 342–343
Blalock-Taussig shunt, 2
Bleeding, 342, 403
Blood management
intraoperative
hemostasis testing, 102, 103
nonpharmacologic intervention for
blood conservation, 102
perfusion interventions to reduce blood
loss, 104
pharmacologic intervention for
bleeding prevention, 102
post-bypass and postoperative
lab studies, 105
transfusion triggers, 105
Blood pressure monitor, 93
Blue babies, 3
Blunt abdominal aortic injury (BAAI), 263,
266, 269
Blunt thoracic aortic injuries (BTAI), 262,
264, 265
Blunt thoracic aortic trauma, 262
Bovine arch, 23, 216
Bretschneider solution, 122
Bridge to transplant (BTT)., 337
Buckberg solution, 121
Bundle of His, 24
C
Calcium score scan, 60, 62
Cannulation strategy, 110, 254
axillary, right subclavian, innominate, and
other arch branch arterial
cannulation, 255
direct aortic, 255
femoral, 254
Carbon dioxide (CO2) monitor, 93
Cardiac catheterization, 280, 294
with coronary angiography, 37
Cardiac chamber assessment, 60
Cardiac computer tomography (CCT), 301
Cardiac Index, 396
Cardiac magnetic resonance
(CMR), 301, 308
Cardiac mass, contrast-enhanced scan, 70
Cardiac metabolic demand, in different states,
117, 118
Cardiac MRI, 168
imaging nding, 72–75
indications
ow and function evaluation, 71
tissue characterization, 71
patient selection, 71
protocol, 72
Cardiac operating room teams
culture of safety, promoting, 390
preoperative brieng, impact of, 390
roles/responsibilities
anesthesia team, 388
cardiac surgery, 387, 388
nursing team, 389
perfusion, 388, 389
scrub person, 389
variations in cognitive load during cardiac
surgery, 389, 390
Cardiac output (CO), 396
Cardiac surgery, history of, 2
early, 1–3
minimally invasive cardiac surgery, 10, 11
myocardial protection, 5–7
open heart surgery, 3, 4
transplantation, 9, 10
valve repair and replacement, 7–9
Cardiac tamponade, 403, 404
Cardiogenic shock, 328, 346
Cardioplegia, 6, 7
for congenital heart surgery, 7
ow and pressure, 120, 121
mode of delivery, 120
optimization of, 6
Cardioplegic solutions, 118, 121, 122
avoidance of myocardial edema, 119
avoidance of substrate depletion, 119
buffering of, 119
hypothermia, 120
rapid cardiac arrest, 119
412
https://t.me/medicina_free
Index
Cardiopulmonary bypass (CPB), 97, 98, 278,
281, 296, 340, 349
CABG using, 128, 129
cannulation strategies, 110
circulatory arrest and special
considerations, 114, 115
cooling and warming, 112
criteria for discontinuing, 114
heparin dosage and reversal, 111
initiation, 112, 113
optimal ow rate and MAP, 111, 112
separation, 113
Carotid artery studies, 39, 40
Carpentier classication system, 154
Catheter ablation techniques, 287
Cell salvage, 104
Cell saver, 104
Central brous body, 19
Central venous oxygen saturation (ScvO2), 400
Central venous pressure (CVP), 97, 397
CentriMag®, 320, 322
Cerebral oximeter, 94
Cerebral perfusion pressure (CPP), 234
Chest CT, 35
Chest tube patency, 404
Chest x-ray (CXR), 35
Chest x-rays evaluation, 400
Child-Turcotte-Pugh score, 34
Chronic obstructive pulmonary disease
(COPD), 355
Chronic pulmonary embolism (PE)
indication for surgery, 280
pathogenesis, 279
presentation and diagnosis, 280
pulmonary thromboendarterectomy,
operative techniques for, 281, 282
Chronic thromboembolic pulmonary
hypertension (CTEPH),
276, 279–281
Chronic total occlusion (CTO), 60
Circulatory arrest, 114
Clamshell incision, 360
Coagulopathy, 106
Coarctation, 80
Cognitive workload, 390
Complete metabolic prole (CMP), 33
Complex multi-valve endocarditis, 210
Composite valve conduit root
replacement, 221
Computed tomographic angiography
(CTA), 36, 229
Computed tomography (CT), 59
aorta, pre-procedural, 80, 81
contrast-enhanced scan (see Contrast-
enhanced scan)
indications, 60, 61
non-contrast/calcium score scan, 62
patient selection, 61
protocol, 61, 62
scan, 251
Computed tomography pulmonary angiogram
(CT-PA), 277, 280
Conduction system, 24, 25
Cone repair, 173
Congenital heart disease, 72, 170
Congenital tricuspid valve dysplasia, 166, 170
Constrictive pericarditis, 291, 292
Contractility, 394
Contrast echocardiography, 58
Contrast-enhanced scan
cardiac mass, 70
coronary arteries
anomalies, 63
CAD, 63, 65
coronary artery aneurysm, 67
coronary artery dissections, 66
valvular disease
infective endocarditis, 68, 69
pre-transcatheter procedure
assessment, 67, 68
valvular masses, 69
Contrast media, 83
Cor triatriatum, 379
Cor triatriatum dexter (CTD), 379–381
Cor triatriatum sinister (CTS), 379
Corevalve Evolut (self-expanding), 197
Coronary angiography, 18, 83, 84, 137
access, 84
imaging modalities, 86, 87
percutaneous coronary intervention, 87
stent choice and DAPT duration, 88
vs. PTCA, 88
vs. surgical revascularization, 87, 88
physiologic assessment, 86
RHC, 90
access, 90
data, 90
indications, 89
standard projections and catheterization
laboratory setup, 84, 85
Coronary angiography, cardiac catheterization
with, 37
Coronary arteries
computed tomography angiography of, 36
contrast-enhanced scan
anomalies, 63
Index
https://t.me/medicina_free
413
CAD, 63, 65
coronary artery aneurysm, 67
coronary artery dissections, 66
Coronary artery anomalies, 369
imaging, 370
origin, 369–370
risk of sudden cardiac death, 370
surgical repair, 370
Coronary artery bypass grafting (CABG), 28,
128–130, 136
Coronary artery disease (CAD), 63, 65
CABG using CPB, 128, 129
conduit options, 128
epidemiology and pathophysiology, 123
indications for revascularization,
124, 125
on pump versus off pump coronary artery
bypass, 129, 130
staples of medical management, 124
Coronary artery dissections, 66
Coronary CT angiogram (CTA), 60
Coronary CT fractional ow reserve (CT
FFR), 63
Coronary lesions, 95
Coronary plaque, 87
Coronary revascularization, 124
Coronary sinus, 19
Coronary veins, 19
Cox-Maze, 284–286
Crawford/Sa classication, 227
Cross-circulation, 4, 5
postoperative care and complications,
243, 244
testing, 229, 230
Destination therapy (DT), 337
Diastolic arrest, 121
Diastolic dysfunction, 57
Diastolic function, 57
Diastolic hyperemia-free radio (DFR), 86
Dimensionless index (DI), 52
Direct acting oral anticoagulants
(DOACs), 277
Direct procurement and perfusion (DPP), 349
Dobutamine, 96
Donation after brain death (DBD), 349, 350
Donation after circulatory death (DCD), 349,
350, 352
Donor cardiectomy, 350
Donor pneumonectomy, 358–360
Doppler echocardiography, 49
Double-lung transplants, 10
DPP protocol, 351
Dual antiplatelet therapy (DAPT), 88, 101
Dual stage cannulation, 110
Durable mechanical circulatory support
devices, 339
left ventricular support, 337, 338
post-operative complications, 341, 342
REMATCH clinical trial, 339
right ventricular support, 342, 343
surgical implantation techniques, 340, 341
Dyspnea, 307
D
Dacron tube graft, 242
David reimplantation technique, 220
D-dimer, 276
Deep hypothermic circulatory arrest
(DHCA), 221
Deep venous thrombosis (DVT)., 275
Degenerative aneurysms, 223
del Nido solution, 121
Descending aorta, 254
Descending thoracic aortic aneurysms
(DTAAs), 227
endovascular repair of, 232–234
history and physical examination, 229
management and treatment, 231, 232
open repair of, 235, 236
arterial reconstruction, 241
closure, 242, 243
extracorporeal circulation, 238–240
incision and exposure, 236, 237
E
Ebstein anomaly, 166, 170
Ebstein repair, 174
Echocardiogram, 276, 280, 397
Echocardiography, 36, 68, 293, 294
common cardiac pathologies
aortic regurgitation, 52
diastolic function, 57
left ventricular function, 56
mitral regurgitation, 54
mitral stenosis, 53
tamponade and constriction, 56, 57
tricuspid regurgitation, 55, 56
valvular aortic stenosis, 52
contrast, 58
stress, 58
TEE, 50, 51
tricuspid valve, 168
TTE, 49, 50
Ectasia, 217
Соседние файлы в папке Библиотека им академика М.И. Перельмана