Case Report. Anaesthetic Management for Birth in the presence of a rare form of Congenital Heart Disease. Dr. Moritz Schürch
|
|
- Bertina Neal
- 5 years ago
- Views:
Transcription
1 Case Report Anaesthetic Management for Birth in the presence of a rare form of Congenital Heart Disease Dr. Moritz Schürch
2 The Question anaesthetic consultation: assessment and management plan for birth 22 yo 1GOP; 34 weeks of gestation Congenital Heart Disease: Shone s Syndrom
3 The Question anaesthetic consultation: assessment and management plan for birth 22 yr old 1GOP; 34 weeks of gestation Congenital Heart Disease: Shone s Syndrom bicuspid aortic valve with combined lesion coarctation repair 9/88 und 6/95 reconstruction of aortic valve, repair of subaortic stenosis and ventriculotomy 10/92 recurrent moderate coarctation: p-mean 32 mmhg
4 The Cardiologists Opinion Stable situation Coarctation still moderate No objection against vaginal delivery Delivery in a hospital with cardiologist If cesarean delivery is required they recommend general anaesthesia peripheral vasoplegia under spinal anaesthesie with danger of poststenotic hypotension and compromised uterine perfusion
5 Outline What is Shone s Syndrom? Information in textbooks and guidelines? Information in published papers? What shall we do in the actual case? Discussion
6 Shone s Syndrom First Publication:
7 Shone s Syndrom Morphogenesis The mitral valve complex and the left ventricular outflow tract are an entity, forming the medial and superior portion of the ventricle Congenital malformations of the mitral valve can affect the anatomy of the subaortic region One abnormality upstream can during morphogenesis result in distal defects due to abnormalities in flows
8 Shone s Syndrom Supravalvular Ring of left Atrium circumferential fibrous ring hypoplastic mitral valve +/- malformation of the leaflets Parachute Mitral Valve missing anterior papillary muscle, chordae converge onto one large papillary muscle, parachute like appearance Subaortic Stenosis Coarctation of the Aorta usually peri- or postductal 0.6% of all cases of CHD, : = 1.5 : 1
9 Shone s in TEE ME-4Ch dtg-lax ME-lax Ray Liao, Washington UE-aortic-arch-lax
10 Shone s Syndrom: Correction Sekhar, Indian J. Anaesth 2004
11 Our Patient 22 yr old 1GOP; 34th week of gestation Congenital Heart Disease: Shone s Syndrom bicuspid aortic valve with combined lesion coarctation repair 9/88 und 6/95 reconstruction of aortic valve, repair of subaortic stenosis and ventriculotomy 10/92 recurrent moderate coarctation: p-mean 32 mmhg
12 How shall we proceed? Vaginal Delivery? with Option of Epidural? without Option of Epidural? Plan B in case of need for cesarean section? Elective Cesaren Section? With spinal anaesthesia? With epidural anaesthesia? With general Anaesthesia? Transfer to St. Elsewhere-Hospital? Other suggestions?
13 How shall we proceed? Vaginal Delivery? with option of epidural analgesia? without option of epidural analgesia? Plan B in case of need for cesarean section? Elective Cesarean Section? With spinal anaesthesia? With epidural anaesthesia? With general Anaesthesia? Transfer to St. Elsewhere-Hospital? Other suggestions?
14 An exposed path with uncertain exit?
15 That s what Textbooks and Guidelines say
16 The Textbooks No concrete information about Shone s Syndrom Aortic Stenosis and Coarctation of the Aorta: Vaginal Delivery: systemic medication, inhalational analgesia, pudendal nerve block AS: extreme caution with techniques that reduce systemic vascular resistance and venous return Cesarean section: light general anaesthesia, maintain increased level of heart rate, contractility and vascular resistance
17
18 Risk in Pregnancy and (C)HD cardiac dis. in preg. Tutorial 1&2 Reide, Yentis; j.bpobgyn 2010 Dob, Yentis; Int J Obstet Anaesth. 2006
19
20
21
22 That s what published papers say
23 Shone s und Anästhesie
24 Shone s, SS und Anästhesie
25 Shone s und SS 15 yr old 1G 0P 25 weeks of gestation Dyspnea on exertion since age of 9, increasing during pregnancy, flue like symptoms since one week BP 150/98 mmhg, Hf 102/min, RF 22 Rx: pulmonary edema TTE: - severe MS, supravalv. Ring, p-mean 22mmHg - 2 papillary muscels, MV: no parachute-configuration - bicucpide AV, Coarctation with p 70mmHg Dg: Shone-Syndrom
26 Shone s und SS Therapy Bed rest, treatment with Furosemide and -blocker Transfusion of 2 packed RBCs at Hb 10.9 g/dl Reduction von PAP sys from 70 to 50 mmhg Reduction p-mean over MV from 22 to 14 mmhg Induction of labour at 37 weeks with radial arterial line, hemodynamically stable, uncomplicated delivery Discharge 4 days after delivery partum with follow up by cardiologist
27 Shone s und SS Discussion Hemodynamic changes during pregnancy can cause decompensation of CHD It is not coincidental that the patient presented at 25 weeks gestation, since this is the time in pregnancy when cardiac output is maximal Cardiac decompensation during pregnancy needs careful evaluation Surgical correction during pregnancy would most likely result in a high fetal mortality rate
28
29 Shone s und Sectio 17 yr old 1G 0P 39 weeks of gestation Shone s Syndrom, parachute MV with mild stenoses, bicuspide AV, mild subaortic stenosis Followed in congenital heart clinic since 2 year old. At 14 yrs fatigue with exercise, mild MS and AS, no intervention At 16 yrs pediatric cardiology clinic: 16 wk gestation at 26 wk: p-mean MV 6mmHg, p-mean suba 36mmHg At 36 wk: decision cesarean section based upon multiple level heart obstruction and symptoms
30 Shone s und Sectio Cesarean Delivery at 39 weeks of gestation BP 103/51 mmhg, Hf 93/min, SpO 2 (Air) 98% EKG, NIBP (1x/min), SpO 2, O 2 nasal, 500ml RL EDA (L3/4, si. med.), Lido 2% +Adr. 2x1.5ml / 3ml BP-drop to 82/30mmHg, 54/30mmHg despite Phenylephrine, Ephedrine, RL. FHR 60/min after normalising BP; immediate delivery Inadequate Block; GA RSI (Pento 100mg, Succi) Healthy infant, APGAR 9/9, ph 7.13
31 Shone s und Sectio Discussion Optimal anesthetic technique for cesarean delivery in patients with stenotic valvular lesions is controversial Etiology of the rapid and profound hypotension after 6ml of epidural Lidocaine is unclear initiate invasive monitoring before the initiation of anesthesia patients should be managed by a multidisciplinary team with a management plan regarding the timing and mode of delivery
32 Coarctation and Cesarean Section T. Togal (EJA 2002; 19:760-73) 20 yr old patient 40 weeks of gestation BD 230/97mmHg re; 107/67 mmhg li Arm diminished lower extremity pulses Echo: 50% narrowing of aortic isthmus, LVEF 67% Fetal distress demands urgent Cesarean Section right radial arterial and internal jugular catheter; GA with RSI; Etomidate, Alfentanil, Succinylcholin, Vecuronium, Sevoflurane, N2O/O2 Avoidance of sympathetic block that occurs with RA. Risk of significant hypotension (blood flow to fetus!)
33 Coarctatio und SS
34 Coarctatio und SS
35 Back to our Question What should we recommend?
36 How shall we proceed? Vaginal Delivery? with option of epidural analgesia? without option of epidural analgesia? Plan B in case of need for cesarean section? Elective Cesarean Section? With spinal anaesthesia? With epidural anaesthesia? With general Anaesthesia? Transfer to St. Elsewhere-Hospital? Other suggestions?
37 Our Consideration Avoidance of neuraxial Block Effect on poststenotic Blood Pressure with compormised uteroplacentar perfusion? Avoidance of urgent Cesarean Delivery Availability of experienced anaesthesiologist and cardiologist! Reduction of Risk with planned Cesarean Section? Availability of anaesthesiologist and cardiologist invasive monitoring, availability of TEE ideal: procedure in central operation tract
38 X
39 Implementation Planned CS 38 5 / 7 weeks of gestation ECG, NIBP (li), SpO2, peripheral Line right A. brachialis cath. (A.rad. Ø US-signal) NIBPleft 95/52mmHg, IBPright 142/92mmHg CO-monitoring (LiDCO Rapid), TEE ready GA RSI Thiopental (350mg), Fentanyl (0.1mg), Succinylcholin (60mg), N2O/O2, Isoflurane After cord clamping: Clamoxyl 1g, Syntocinon 5 E (slow infusion), Change to Propofol Ephedrine S 10mg, Phenylephrine S 0.15mg Blood loss 650ml, RL 900ml
40 Hämodynamics Induction 4 Ephedrin 10mg 2 Intubation, Knife to Skin Phenylephrin 0.15mg 3 Syntocinon 5 IE KI 5 Extubation
41 TTE
42 Postoperative Course Transfer to Intensive Care Unit Extubatet immediately after surgery Hemodynamically stable Uneventful postoperative Course Transfer to puerperal ward on the same day Uneventful post-partum period Discharged home on the 5 th postoperative day with a healthy baby
43
44
45
46 ? ; urgent CS 37 yr old 1G 0P 40 3 / 7 weeks of gestation Amniotic infection syndrome, mildly preeclamptic Loud systolic murmur Scar from Sternotomy; Correction of congenital heart disease at the age or 4 No documentation at all! Narrowing of one of the arteries, little whole at the other artery!
47 Discussion? Thank you!
Cardiovascular Effects of Anesthesia for Cesarean Delivery in the Cardiac Patient
Cardiovascular Effects of Anesthesia for Cesarean Delivery in the Cardiac Patient Katherine W. Arendt, M.D. Associate Professor of Anesthesiology Mayo Clinic, Rochester, Minnesota Cardiac Problems in Pregnancy
More informationCase Report A Multidisciplinary Approach to Anesthetic Management of a Parturient with Severe Aortic Stenosis
Case Reports in Anesthesiology Volume 2015, Article ID 489157, 4 pages http://dx.doi.org/10.1155/2015/489157 Case Report A Multidisciplinary Approach to Anesthetic Management of a Parturient with Severe
More informationCardiac disease in pre pr gnancy
IN THE NAME OF GOD Cardiac disease in pregn nancy MITRAL STENOSIS 33 y/o G3L2(2c/s) GA 34 + 5 CC: LP & dyspnea PMHx: MS sinse 4 yrs ago due to Rheumatism PSHx: 2c/s DHx: metoral 50 mg q6h/ ASA/ Enoxaparin
More informationScreening for Critical Congenital Heart Disease
Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most
More informationValve Disease in the Pregnant Patient
Valve Disease in the Pregnant Patient Julie B. Damp, MD December 6, 2012 VanderbiltHeart.com If single, do not allow marriage. If fertile, do not allow pregnancy. If pregnant, do not allow delivery. If
More informationNothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
More informationHISTORY. Question: What category of heart disease is suggested by the fact that a murmur was heard at birth?
HISTORY 23-year-old man. CHIEF COMPLAINT: Decreasing exercise tolerance of several years duration. PRESENT ILLNESS: The patient is the product of an uncomplicated term pregnancy. A heart murmur was discovered
More informationMore History. Organization. Maternal Cardiac Disease: a historical perspective. The Parturient with Cardiac Disease 9/21/2012
The Parturient with Cardiac Disease Pamela Flood M.D. Professor of Anesthesia and Perioperative Care Obstetrics, Gynecology and Reproductive Sciences University of California, San Francisco Maternal Cardiac
More informationPerioperative Management of DORV Case
Perioperative Management of DORV Case James P. Spaeth, MD Department of Anesthesia Cincinnati Children s Hospital Medical Center University of Cincinnati Objectives: 1. Discuss considerations regarding
More informationHISTORY. Question: What category of heart disease is suggested by this history? CHIEF COMPLAINT: Heart murmur present since early infancy.
HISTORY 18-year-old man. CHIEF COMPLAINT: Heart murmur present since early infancy. PRESENT ILLNESS: Although normal at birth, a heart murmur was heard at the six week check-up and has persisted since
More informationHow to Assess and Treat Obstructive Lesions
How to Assess and Treat Obstructive Lesions Erwin Oechslin, MD, FESC, FRCPC, Director, Congenital Cardiac Centre for Adults Peter Munk Cardiac Centre University Health Network/Toronto General Hospital
More informationAORTIC COARCTATION. Synonyms: - Coarctation of the aorta
AORTIC COARCTATION Synonyms: - Coarctation of the aorta Definition: Aortic coarctation is a congenital narrowing of the aorta, usually located after the left subclavian artery, near the ductus or the ligamentum
More information14 Valvular Stenosis
14 Valvular Stenosis 14-1. Valvular Stenosis unicuspid valve FIGUE 14-1. This photograph shows severe valvular stenosis as it occurs in a newborn. There is a unicuspid, horseshoe-shaped leaflet with a
More informationPREGNANCY AND CONGENITAL HEART DISEASE
PREGNANCY AND CONGENITAL HEART DISEASE SIDDHARTH JADHAV M.D. Assistant Professor of Radiology E.B. Singleton Department of Pediatric Radiology Texas Children's Hospital COMMERCIAL DISCLOSURE - None Objectives
More informationLEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT
LEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT 10-13 March 2017 Ritz Carlton, Riyadh, Saudi Arabia Zohair AlHalees, MD Consultant, Cardiac Surgery Heart Centre LEFT VENTRICULAR
More informationMaternal Cardiac Disease In Pregnancy. August 25, 2017 PREGNANCY ECHO CONFERENCE
Maternal Cardiac Disease In Pregnancy August 25, 2017 PREGNANCY ECHO CONFERENCE Maternal Physiology Cardiac Output = HR x SV Non-pregnant: 4.5 L/min Pregnant: 6.0 L/min Increase most acute in first 10
More informationHypoplastic Left Heart Syndrome: Echocardiographic Assessment
Hypoplastic Left Heart Syndrome: Echocardiographic Assessment Craig E Fleishman, MD, FACC, FASE Director, Non-invasive Cardiac Imaging The Hear Center at Arnold Palmer Hospital for Children, Orlando SCAI
More informationECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT
ECHOCARDIOGRAPHIC APPROACH TO CONGENITAL HEART DISEASE: THE UNOPERATED ADULT Karen Stout, MD, FACC Divisions of Cardiology University of Washington Medical Center Seattle Children s Hospital NO DISCLOSURES
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS Pediatric Cardiology
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationPeripartum management of Rheumatic Heart Disease
Peripartum management of Rheumatic Heart Disease Dr James Sartain Director of Anaesthesia & Perioperative Medicine Cairns & Hinterland Hospital & Health Service Talk outline Why (still) talk about RHD
More informationAnaesthesia for non-cardiac surgery in patients left ventricular outflow tract obstruction (LVOTO)
Anaesthesia for non-cardiac surgery in patients left ventricular outflow tract obstruction (LVOTO) Dr. Siân Jaggar Consultant Anaesthetist Royal Brompton Hospital London UK Congenital Cardiac Services
More informationANESTHESIA EXAM (four week rotation)
SPARROW HEALTH SYSTEM ANESTHESIA SERVICES ANESTHESIA EXAM (four week rotation) Circle the best answer 1. During spontaneous breathing, volatile anesthetics A. Increase tidal volume and decrease respiratory
More informationCASE DISCUSSION. Dr JAYASREE VEERABOINA 2nd yr PG MS OBG
CASE DISCUSSION Dr JAYASREE VEERABOINA 2nd yr PG MS OBG Normal Cardiovascular changes in Pregnancy CARDIAC OUTPUT 5 th wk -- starts 12 wks -- 30-35% 30-32 wks -- 40% During labour -- 50% After delivery
More informationPre-eclampsia: key issues. Robin Russell Nuffield Department of Anaesthetics John Radcliffe Hospital Oxford
Robin Russell Nuffield Department of Anaesthetics John Radcliffe Hospital Oxford Antenatal Issues Labour Analgesia Anaesthesia for Delivery High Dependency Care Hypertension systolic >140 mmhg or diastolic
More informationWhat is the Definition of Small Systemic Ventricle. Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University
What is the Definition of Small Systemic Ventricle Hong Ryang Kil, MD Department of Pediatrics, College of Medicine, Chungnam National University Contents Introduction Aortic valve stenosis Aortic coarctation
More informationClinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!!
Clinicians and Facilities: RESOURCES WHEN CARING FOR WOMEN WITH ADULT CONGENITAL HEART DISEASE OR OTHER FORMS OF CARDIOVASCULAR DISEASE!! Abha'Khandelwal,'MD,'MS' 'Stanford'University'School'of'Medicine'
More informationPregnancy, Heart Disease and Imaging. Hemodynamics. Decreased systemic vascular resistance. Physiology anemia
Pregnancy, Heart Disease and Imaging Sangeeta Shah, MD, FASE, FACC Associate Professor, Ochsner Clinical School of Medicine Advanced CV Imaging and Adult Congenital Heart Disease New Orleans, LA Hemodynamics
More informationEVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE. Karen Stout, MD University of Washington Seattle Children s Seattle, WA
EVALUATION OF PREGNANT PATIENTS WITH HEART DISEASE Karen Stout, MD University of Washington Seattle Children s Seattle, WA CASE PRESENTATION 24 year old woman with aortic regurgitation referred for evaluation
More informationAnatomy & Physiology
1 Anatomy & Physiology Heart is divided into four chambers, two atrias & two ventricles. Atrioventricular valves (tricuspid & mitral) separate the atria from ventricles. they open & close to control flow
More informationHow to Recognize a Suspected Cardiac Defect in the Neonate
Neonatal Nursing Education Brief: How to Recognize a Suspected Cardiac Defect in the Neonate https://www.seattlechildrens.org/healthcareprofessionals/education/continuing-medical-nursing-education/neonatalnursing-education-briefs/
More information5.8 Congenital Heart Disease
5.8 Congenital Heart Disease Congenital heart diseases (CHD) refer to structural or functional heart diseases, which are present at birth. Some of these lesions may be discovered later. prevalence of Chd
More informationAdult Congenital Heart Disease: A Growing Problem. Dr. Gary Webb Cincinnati Children s Hospital Heart Institute
Adult Congenital Heart Disease: A Growing Problem Dr. Gary Webb Cincinnati Children s Hospital Heart Institute ACHD Resources in Ohio ACHAHEART.ORG Situations When We Might Help When you don t know a
More informationCongenital heart disease. By Dr Saima Ali Professor of pediatrics
Congenital heart disease By Dr Saima Ali Professor of pediatrics What is the most striking clinical finding in this child? Learning objectives By the end of this lecture, final year student should be able
More informationCongenitally Corrected Transposition of the Great Arteries (cctga or l-loop TGA)
Congenitally Corrected Transposition of the Great Arteries (cctga or l-loop TGA) Mary Rummell, MN, RN, CPNP, CNS Clinical Nurse Specialist, Pediatric Cardiology/Cardiac Surgery Doernbecher Children s Hospital,
More informationMITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT. Irene Frantzis P year, SGUL Sheba Medical Center
MITRAL VALVE DISEASE- ASSESSMENT AND MANAGEMENT Irene Frantzis P year, SGUL Sheba Medical Center MITRAL VALVE DISEASE Mitral Valve Regurgitation Mitral Valve Stenosis Mitral Valve Prolapse MITRAL REGURGITATION
More information3 European Journal of Heart Failure 2016; 18,
Impella Assisted Cesarean Delivery in a 27 6/7 Weeks Gestation 30 Year Old Female with Newly Diagnosed Cardiomyopathy & Multifocal Incessant Ventricular Tachycardia Brendan J Carry, MD, Jason Costa, MD,
More informationULTRASOUND OF THE FETAL HEART
ULTRASOUND OF THE FETAL HEART Cameron A. Manbeian, MD Disclosure Statement Today s faculty: Cameron Manbeian, MD does not have any relevant financial relationships with commercial interests or affiliations
More informationPeripartum Anesthetic Management in Patients with Left Ventricular Hypertrabeculation
Peripartum Anesthetic Management in Patients with Left Ventricular Hypertrabeculation Marissa L. Kauss, M.D. Fellow, Cardiovascular Anesthesia Mayo Clinic, Rochester, Minnesota Cardiac Problems in Pregnancy
More informationPregnancy and Heart Disease. Shilpa Kshatriya, MD, FACC Heartland Cardiology, PA
Pregnancy and Heart Disease Shilpa Kshatriya, MD, FACC Heartland Cardiology, PA Pregnancy and the Heart 2 % of pregnancies involve maternal CV disease CV disease does not preclude pregnancy but poses risk
More informationLeft Ventricular Outflow Tract Obstruction
Left Ventricular Outflow Tract Obstruction Department of Paediatrics Left Ventricular Outflow Tract Obstruction Subvalvular aortic stenosis Aortic Stenosis Supravalvular aortic stenosis Aortic Coarctation
More informationPregnancy and Heart Disease
Pregnancy and Heart Disease Heidi M. Connolly, MD No disclosures 2011 MFMER 3138928-1 Regitz-Zagrosek V, Lundqvist C, Borghi C, et al. Pregnancy and the Heart 2% of pregnancies involve maternal CV disease
More informationSredišnja medicinska knjižnica
Središnja medicinska knjižnica Vincelj, J., Sokol, I., Pevec, D., Sutlić, Ž. (2007) Infective endocarditis of aortic valve during pregnancy: A case report. International Journal of Cardiology, [Epub ahead
More informationBy the end of this session, the student should be able to:
Valvular Heart disease HVD By Dr. Ashraf Abdelfatah Deyab VHD- Objectives By the end of this session, the student should be able to: Define and classify valvular heart disease. Enlist the causes of acquired
More informationThe Role of the Anaesthesiologist in the Perioperative Management of Preeclampsia. RA Dyer Interlaken 2017
The Role of the Anaesthesiologist in the Perioperative Management of Preeclampsia RA Dyer Interlaken 2017 6 In preeclampsia - Understanding of pathophysiology Assessment of disease severity Prediction
More informationOutline. Congenital Heart Disease. Special Considerations for Special Populations: Congenital Heart Disease
Special Considerations for Special Populations: Congenital Heart Disease Valerie Bosco, FNP, EdD Alison Knauth Meadows, MD, PhD University of California San Francisco Adult Congenital Heart Program Outline
More informationCONGENITAL HEART DISEASE (CHD)
CONGENITAL HEART DISEASE (CHD) DEFINITION It is the result of a structural or functional abnormality of the cardiovascular system at birth GENERAL FEATURES OF CHD Structural defects due to specific disturbance
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationAortic Stenosis: LVOT Obstruction
Aortic Stenosis: LVOT Obstruction Raymond Stainback, MD 7 th annual Houston Echo Review 2016: Boot Camp for the Echo Board Murmur: Additional heart or vascular sound due to normal or abnormal turbulent
More informationEjection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease Etiology General Principles Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
More informationNotes by Sandra Dankwa 2009 HF- Heart Failure DS- Down Syndrome IE- Infective Endocarditis ET- Exercise Tolerance. Small VSD Symptoms -asymptomatic
Congenital Heart Disease: Notes. Condition Pathology PC Ix Rx Ventricular septal defect (VSD) L R shuntsdefect anywhere in the ventricle, usually perimembranous (next to the tricuspid valve) 30% 1)small
More informationCongenital Heart Disease Cases
Congenital Heart Disease Cases Sabrina Phillips, MD FACC FASE Mayo Clinic Congenital Heart Disease Center 2013 MFMER slide-1 No Disclosures 2013 MFMER slide-2 1 CASE 1 2013 MFMER slide-3 63 year old Woman
More informationPediatric Jehovah's Witness Patient with Shone's Complex and Mitral Stenosis and Pulmonary Hypertension Presenting for Posterior Spinal Fusion
PBLD Table #: 38 Pediatric Jehovah's Witness Patient with Shone's Complex and Mitral Stenosis and Pulmonary Hypertension Presenting for Posterior Spinal Fusion Moderators: Brian Blasiole, M.D., Ph.D. and
More informationFoetal Cardiology: How to predict perinatal problems. Prof. I.Witters Prof.M.Gewillig UZ Leuven
Foetal Cardiology: How to predict perinatal problems Prof. I.Witters Prof.M.Gewillig UZ Leuven Cardiopathies Incidence : 8-12 / 1000 births ( 1% ) Most frequent - Ventricle Septum Defect 20% - Atrium Septum
More informationDebate in Management of native COA; Balloon Versus Surgery
Debate in Management of native COA; Balloon Versus Surgery Dr. Amira Esmat, El Tantawy, MD Professor of Pediatrics Consultant Pediatric Cardiac Interventionist Faculty of Medicine Cairo University 23/2/2017
More informationEjection across stenotic aortic valve requires a systolic pressure gradient between the LV and aorta. This places a pressure load on the LV.
Valvular Heart Disease General Principles Etiology Cellular and molecular mechanism of valve damage Structural pathology Functional pathology - stenosis/regurgitation Loading conditions - pressure/volume
More informationSESSION D5. The Heart of the Matter: Cardiac Disease in Pregnancy Brad M. Dolinsky, MD, MFM
37th Annual Advanced Practice in Primary and Acute Care Conference: October 9-11, 2014 2:45 SESSION D5 Session Description: The Heart of the Matter: Cardiac Disease in Pregnancy Brad M. Dolinsky, MD, MFM
More informationEchocardiography in Adult Congenital Heart Disease
Echocardiography in Adult Congenital Heart Disease Michael Vogel Kinderherz-Praxis München CHD missed in childhood Subsequent lesions after repaired CHD Follow-up of cyanotic heart disease CHD missed in
More informationCritical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials
Critical Care in Obstetrics: An Innovative and Integrated Model for Learning the Essentials Pregnancy and Congenital Heart Disease Case Review Heidi M. Connolly, M.D. Professor of Medicine Chair for Education
More informationLarge Arteries of Heart
Cardiovascular System (Part A-2) Module 5 -Chapter 8 Overview Arteries Capillaries Veins Heart Anatomy Conduction System Blood pressure Fetal circulation Susie Turner, M.D. 1/5/13 Large Arteries of Heart
More informationPulmonic Stenosis. How does the heart work?
Pulmonic Stenosis How does the heart work? The heart is the organ responsible for pumping blood to and from all tissues of the body. The heart is divided into right and left sides. The job of the right
More informationSWISS SOCIETY OF NEONATOLOGY. Prenatal closure of the ductus arteriosus
SWISS SOCIETY OF NEONATOLOGY Prenatal closure of the ductus arteriosus March 2007 Leone A, Fasnacht M, Beinder E, Arlettaz R, Neonatal Intensive Care Unit (LA, AR), University Hospital Zurich, Cardiology
More informationCongenital Heart Disease
Congenital Heart Disease Mohammed Alghamdi, MD, FRCPC, FAAP, FACC Associate Professor and Consultant Pediatric Cardiology, Cardiac Science King Fahad Cardiac Centre King Saud University INTRODUCTION CHD
More informationImaging Cardiovascular Disease in Pregnancy
Imaging Cardiovascular Disease in Pregnancy Karen Ordovas MD, MAS Associate Professor of Radiology and Medicine Director of Cardiac Imaging University of California San Francisco Cardiac MRI during pregnancy
More informationPERIPARTUM CARDIOMYOPATHY
PERIPARTUM CARDIOMYOPATHY Dr.T.Venkatachalam. Professor of Anaesthesiology Madras Medical College, Chennai Peripartum cardiomyopathy is defined as the onset of acute heart failure without demonstrable
More informationTGA atrial vs arterial switch what do we need to look for and how to react
TGA atrial vs arterial switch what do we need to look for and how to react Folkert Meijboom, MD, PhD, FES Dept ardiology University Medical entre Utrecht The Netherlands TGA + atrial switch: Follow-up
More informationPATENT DUCTUS ARTERIOSUS (PDA)
PATENT DUCTUS ARTERIOSUS (PDA) It is a channel that connect the pulmonary artery with the descending aorta (isthumus part). It results from the persistence of patency of the fetal ductus arteriosus after
More informationHeart and Lungs. LUNG Coronal section demonstrates relationship of pulmonary parenchyma to heart and chest wall.
Heart and Lungs Normal Sonographic Anatomy THORAX Axial and coronal sections demonstrate integrity of thorax, fetal breathing movements, and overall size and shape. LUNG Coronal section demonstrates relationship
More informationMaternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
ISPUB.COM The Internet Journal of Gynecology and Obstetrics Volume 19 Number 1 Maternal And Fetal Outcome In Pregnancies Complicated With Maternal Cardiac Diseases: Experience At A Tertiary Care Hospital
More informationCongenital Heart Defects
Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass
More informationHeart Failure Dr ahmed almutairi Assistant professor internal medicin dept
Heart Failure Dr ahmed almutairi Assistant professor internal medicin dept (MBBS)(SBMD) Introduction Epidemiology Pathophysiology diastolic/systolic Risk factors Signs and symptoms Classification of HF
More informationAppropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Pediatric Cardiology (scores listed by Appropriate Use rating)
Appropriate Use Criteria for Initial Transthoracic Echocardiography in Outpatient Pediatric Cardiology (scores listed by Appropriate Use rating) Table 1: Appropriate indications (median score 7-9) Indication
More informationImages in Cardiovascular Medicine
Images in Cardiovascular Medicine Management of Severe Mitral Stenosis During Pregnancy Rebecca S. Norrad, MBBS; Omid Salehian, MSc, MD, FRCPC, FACC, FAHA A 37-year-old woman originally from Iraq was referred
More informationHISTORY. Question: What type of heart disease is suggested by this history? CHIEF COMPLAINT: Decreasing exercise tolerance.
HISTORY 15-year-old male. CHIEF COMPLAINT: Decreasing exercise tolerance. PRESENT ILLNESS: A heart murmur was noted in childhood, but subsequent medical care was sporadic. Easy fatigability and slight
More informationCongenital. Unicuspid Bicuspid Quadricuspid
David Letterman s Top 10 Aortic Stenosis The victim can be anyone: Echo is the question and the answer!!!! Hilton Head Island Echocardiography Conference 2012 Timothy E. Paterick, MD, JD, MBA Christopher
More informationKeywords: Caesarean section, segmental epidural anesthesia, Taussig-Bing anomaly
Anesthesia essays and researches CASE REPORT Year : 2015 Volume : 9 Issue : 3 Page : 408-410 Segmental epidural anesthesia for cesarean section in a parturient with uncorrected Taussig Bing anomaly with
More informationAnatomy lab -1- Imp note: papillary muscle Trabeculae Carneae chordae tendineae
Anatomy lab -1- Imp note: the arrangement of this sheet is different than the lab recording, it has been arranged in a certain way to make it easier to study. When you open the left ventricle you can see
More informationAPOLLO TMVR Trial Update: Case Presentation
APOLLO TMVR Trial Update: Case Presentation Anelechi Anyanwu, MD, MSc, FRCS-CTh Professor and Vice-Chairman Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai New York, NY Disclosure
More informationMedical Treatment for acute Decompensated Heart Failure. Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011
Medical Treatment for acute Decompensated Heart Failure Vlasis Ninios Cardiologist St. Luke s s Hospital Thessaloniki 2011 2010 HFSA guidelines for ADHF 2009 focused update of the 2005 American College
More informationPulmonary Hypertension Associated with Congenital Heart Disease. Amiram Nir Hadassah, Jerusalem
Pulmonary Hypertension Associated with Congenital Heart Disease Amiram Nir Hadassah, Jerusalem Disclosure Honoraria - Actelion Research grants form Actelion The Nice Classification (2013) Blok et al. Expert
More informationHeart Valve disease: MR. AS tough patient When to echo, When to refer, What s new
Heart Valve disease: MR. AS tough patient When to echo, When to refer, What s new B. Sonnenberg UAH Cardiology CME Day 5 May 2015 Disclosures Speaker s or Advisory Boards: none Research grants: none (co-investigator
More informationSWISS SOCIETY OF NEONATOLOGY. Prolonged arterial hypotension due to propofol used for endotracheal intubation in a newborn infant
SWISS SOCIETY OF NEONATOLOGY Prolonged arterial hypotension due to propofol used for endotracheal intubation in a newborn infant July 2001 2 Wagner B, Intensive Care Unit, University Children s Hospital
More informationUneventful recovery following accidental epidural injection of dobutamine
1 Case report Uneventful recovery following accidental epidural injection of dobutamine Bastiaan M. Gerritse, M.D., Ph.D., Daan de Vos, R.N.A, Anton W. Visser, M.D., Ph.D. Department of Anesthesiology,
More informationAdult Cardiac Surgery
Adult Cardiac Surgery Mahmoud ABU-ABEELEH Associate Professor Department of Surgery Division of Cardiothoracic Surgery School of Medicine University Of Jordan Adult Cardiac Surgery: Ischemic Heart Disease
More informationAORTIC DISSECTIONS Current Management. TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida
AORTIC DISSECTIONS Current Management TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida DISCLOSURES Terumo Medtronic Cook Edwards Cryolife AORTIC
More informationValvular defects. Lectures from Pathological Physiology. Study materials from Pathological Physiology, 2017/2018 Oliver Rácz, Eva Sedláková
Valvular defects Lectures from Pathological Physiology Study materials from Pathological Physiology, 2017/2018 Oliver Rácz, Eva Sedláková 1 2 3 1 Valvular dysfunction - introduction Stenosis block of flow;
More informationAirway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator
Airway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator Beckerman Z*, Cohen O, Adler Z, Segal D, Mishali D and Bolotin G Department of Cardiac Surgery, Rambam
More informationSupramitral ring (SMR) is a rare developmental abnormality
Supramitral Obstruction of Left Ventricular Inflow Tract by Supramitral Ring Igor Konstantinov, MD, Tae-Jin Yun, MD, Christopher Calderone, MD, and John G. Coles, MD Supramitral ring (SMR) is a rare developmental
More informationCase 47 Clinical Presentation
93 Case 47 C Clinical Presentation 45-year-old man presents with chest pain and new onset of a murmur. Echocardiography shows severe aortic insufficiency. 94 RadCases Cardiac Imaging Imaging Findings C
More informationTranscatheter closure of right coronary artery fistula to the right ventricle
Case Report Transcatheter closure of right coronary artery fistula to the right ventricle Abstract Coronary artery fistula (CAF) is an uncommon anomaly usually congenital but can be acquired. Although,
More informationCYANOTIC CONGENITAL HEART DISEASES. PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU
CYANOTIC CONGENITAL HEART DISEASES PRESENTER: DR. Myra M. Koech Pediatric cardiologist MTRH/MU DEFINITION Congenital heart diseases are defined as structural and functional problems of the heart that are
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACHD. See Adult congenital heart disease (ACHD) Adult congenital heart disease (ACHD), 503 512 across life span prevalence of, 504 506
More informationThe production of murmurs is due to 3 main factors:
Heart murmurs The production of murmurs is due to 3 main factors: high blood flow rate through normal or abnormal orifices forward flow through a narrowed or irregular orifice into a dilated vessel or
More informationAssessment and Preparation of Patients with TAVI. Rob Tanzola Associate Professor, Queen s University
Assessment and Preparation of Patients with TAVI Rob Tanzola Associate Professor, Queen s University My patient has aortic stenosis and needs non-cardiac surgery Should (s)he get a TAVI? Rob Tanzola Associate
More informationAortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants
Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Martin G. Keane, MD, FASE Professor of Medicine Lewis Katz School of Medicine at Temple University Basic root structure Parasternal
More informationDORV: The Great Chameleon. Heart Conference October 15, 2016 Tina Kwan, MD
DORV: The Great Chameleon Heart Conference October 15, 2016 Tina Kwan, MD Kenneth Maehara, Ph.D. May 7, 1942 - August 26, 2013 A.R. A classic case of broken heart 38 week AGA F born at an OSH to
More informationΈγκυος και συγγενής καρδιοπάθεια: Τι πρέπει να γνωρίζει ο Καρδιολόγος Ενηλίκων
Έγκυος και συγγενής καρδιοπάθεια: Τι πρέπει να γνωρίζει ο Καρδιολόγος Ενηλίκων Αντώνιος Π. Βλάχος Αναπληρωτής Καθηγητής Παιδοκαρδιολογίας Πανεπιστήμιο Ιωαννίνων No conflict of interest Pregnancy and CHD
More informationMitral Valve Disease, When to Intervene
Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages
More informationPrinciples of Biomedical Systems & Devices. Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont
Principles of Biomedical Systems & Devices Lecture 8: Cardiovascular Dynamics Dr. Maria Tahamont Review of Cardiac Anatomy Four chambers Two atria-receive blood from the vena cave and pulmonary veins Two
More informationPeripartum Cardiomyopathy. Lavanya Rai Manipal
Peripartum Cardiomyopathy Lavanya Rai Manipal Definition - PPCM - Dilated cardiomyopathy of unknown cause resulting in cardiac failure that occurs in the peripartum period in women without any preexisting
More information