Mitral paravalvular leaks (PVL) occur when there is dehiscence between the prosthetic sewing ring and the native annulus, allowing blood to regurgitate around the valve rather than through it. The prosthesis itself may function normally, while a high velocity eccentric jet produces significant physiologic consequences. These leaks are often associated…
Total pneumonectomy (removal of the entire lung) is most commonly performed for centrally located lung cancer when sleeve resection or lung-sparing surgery is not feasible. Less common indications include severe bronchiectasis, invasive infection, massive hemoptysis, or traumatic destruction of the lung. Unlike lobectomy, pneumonectomy abruptly removes half of the pulmonary…
In patients with extensive disease involving the aortic arch and proximal descending thoracic aorta, a frozen elephant trunk (FET) extends the repair distally by combining an open surgical ascending/transverse aortic arch replacement with deployment of a stented graft into the descending thoracic aorta. This gives my surgical colleagues a way…
Chronic hypertension, medial degeneration, elastic fiber fragmentation, smooth muscle cell loss, and progressive aortic dilation are all mechanisms implicated in acute aortic dissection (AAD). Although cold weather does not create medial degeneration, it can precipitate issues in an already compromised aorta. Population-level data consistently show winter peaks in acute aortic…
As with any procedure, cardiac surgery carries risks that are explained to patients by their surgical team. The Society of Thoracic Surgeons Short-Term Operative Risk Calculator provides clinicians with a way to anchor these discussions. It uses data from hundreds of thousands of cardiac operations to estimate the chance of…
Gerbode defects create an abnormal communication between the high-pressure left ventricle (LV) and the right atrium (RA), thereby completely bypassing the right ventricle. That pathway sets up a distinctive left-to-right shunt with hemodynamics that can be subtle or profoundly destabilizing, depending on the size of the communication and the clinical…
As a cardiac anesthesiologist and intensivist, vasoplegia following cardiopulmonary bypass is an issue I often face in the OR and ICU. This distributive shock phenotype is characterized by low systemic vascular resistance, despite preserved or elevated cardiac output, primarily driven by dysregulated nitric oxide (NO) and guanylate cyclase signaling, which…
Boerhaave syndrome, first described by the Dutch physician Hermann Boerhaave in 1724, is a life-threatening condition involving spontaneous esophageal perforation from a sudden, forceful increase in intraesophageal pressure against a closed glottis (e.g., intense vomiting, retching, or straining). The most common perforation site is the esophagus’s distal third, particularly along…
A pericardial window is a surgical procedure designed to relieve pressure caused by fluid accumulation around the heart, known as pericardial effusion. This fluid can lead to cardiac tamponade, a life-threatening condition where the heart’s ability to fill and maintain a cardiac output is jeopardized. Compared to a pericardiocentesis, where a needle is…
Penetrating atherosclerotic ulcers (PAUs) represent a distinct pathological entity within the spectrum of acute aortic syndromes, characterized by ulceration of atherosclerotic plaque penetrating through the internal elastic lamina into the media of the aortic wall. They typically arise in the setting of advanced atherosclerotic disease, often in patients with a…