CentriMag devices are implanted for acute right and/or left-sided circulatory support but often times used for extended periods of time for patients with acute heart failure awaiting a heart transplant. With CentriMag devices, patients can ambulate and stay conditioned in preparation for their orthotopic heart transplant. These devices rely on…
Left ventricular assist devices (LVADs) like the HeartMate 3 are routinely being implanted as a mechanical circulatory bridge-to-transplant (BTT) or destination therapy (DT). My anesthetic plan for LVAD placement includes general endotracheal anesthesia, arterial line, central venous catheter (oftentimes with PA catheter), and intraoperative transesophageal echocardiography (TEE). In particular with…
A bubble study is often utilized to confirm the presence of shunting across the interatrial septum (IAS) via patent foramen ovale (PFO) or atrial septal defect (ASD). This study combines color flow Doppler and 2D inspection of the IAS anatomy to determine if a defect indeed exists. A Valsalva maneuver…
Yesterday, while at work, I received an email from the National Board of Echocardiography stating that I passed my critical care echocardiography examination!
Orthotopic heart transplantations (OHTs) are some of my favorite procedures as a cardiothoracic anesthesiologist! After establishing general endotracheal anesthesia (GETA) with standard monitors, an arterial line, a central line (often with pulmonary artery catheter), large-bore peripheral intravenous (PIV) access, and transesophageal echocardiography (TEE), the remainder of the procedure is carefully…
The United Network for Organ Sharing (UNOS) is a non-profit organization that oversees national transplant waiting lists, collects data about every organ transplant that occurs in the United States, promotes awareness about the importance of organ donation, and “matches” donors to recipients based on expected benefit, waiting time, geography, blood/tissue…
The overwhelming majority of anesthetics I provide for transcatheter aortic valve replacements (TAVR) are monitored anesthesia care (MAC) – sedation with an anesthesiologist that can escalate the anesthetic. Typically, patients undergoing TAVR are older with many comorbidities making then unsuitable for surgical aortic valve replacements (SAVR). Consequently, it makes sense…
In my first year of anesthesiology residency, I had the opportunity to do a very unique aortic valve replacement (AVR) case for aortic stenosis – the Ozaki repair performed by Dr. Ozaki himself! This incredible surgeon pioneered a technique using the patient’s own pericardium (lining that surrounds the heart) treated…
My ICU colleagues and I walked into yesterday’s first-ever administered critical care ultrasound certification examination without much insight about the exam itself except for a very generic content outline. Here are my reflection/impressions of the test.
As part of my cardiothoracic anesthesia fellowship, we are required to submit an abstract to present at the Society of Cardiovascular Anesthesiologists annual meeting. This will be in May 2019 in Chicago!