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…
Aortic dissection and intramural hematoma (IMH) are both acute aortic syndromes that can present similarly but have distinct pathophysiological differences and implications for management. For example, both can present with acute chest pain radiating to the back, often described as “tearing” or “ripping” in nature with or without hemodynamic instability.…
Kommerell diverticulum (KD) is a rare vascular anomaly typically involving a right-sided aortic arch with an aberrant left subclavian artery. However, variations like a left-sided arch with an aberrant right subclavian artery exist. This condition results from the persistence of an embryonic vascular remnant – the dorsal segment of an…
Marfan syndrome is a genetic condition primarily caused by mutations in the fibrillin-1 (FBN1) gene, which encodes a glycoprotein component of connective tissue. The manifestations of Marfan syndrome result from weakened connective tissues. These include everything from ocular (lens dislocation, retinal detachment, myopia) and cardiovascular (aortic aneurysm, aortic dissection, mitral…
Aortic dissection is a life-threatening condition characterized by a tear in the innermost layer of the aorta (tunica intima), permitting blood to enter and separate the intima from the aorta’s middle layer (tunica media). This event creates a false lumen (FL) alongside the true lumen (TL) of the aorta. Typically,…