Acute ascending aortic dissection (type A) is a true surgical emergency. Arterial walls are comprised of the intima (innermost layer), media, and adventitia (outermost layer). In a dissection, an intimal tear creates a plane between the intima and media and a “false lumen” that can compromise blood flow to branches…
Lumbar drains are a mainstay for spinal cord protection when patients undergo operations like thoracoabdominal aortic aneurysm (TAAA) repairs and thoracic endovascular aortic repairs (TEVAR) with subclavian artery debranching. Why? Because the anterior spinal artery receives contributions from paired intercostal arteries that can be disrupted by the aortic pathology itself…
Over the course of my training as a cardiac anesthesiologist and intensivist, I’ve come across many manifestations of cardiac compression ranging from hemorrhagic pericardial effusions to massive clots. Although the general teaching is to keep these patients “fast, full, and forward” by increasing the heart rate and intravascular volume status,…
The thoracic duct is the primary conduit which carries chyle (lymphatic fluid containing triglycerides, immune cells, proteins, etc.) from the cisterna chyli to the subclavian-jugular vein junction where it empties into the circulatory system. If this duct is disrupted through traumatic (ie, cardiothoracic surgery) or nontraumatic (ie, malignancies like lymphoma)…
Although small amounts of air and fluid in the pleural space are generally well tolerated, pneumothorax, hemothorax, chylothorax, etc., necessitate chest tube placement. Smaller bore tubes can often be utilized and placed more apically for large air collections as air rises. Viscous fluid collections (complicated effusions, hemothorax, empyema, etc.) often…
Deep hypothermic circulatory arrest (“circ arrest”) is often required for partial or total aortic arch reconstructions. At this point in the surgery, there is no blood flow anywhere. Because of systemic cooling, we mitigate the anaerobic and calcium-mediated apoptotic pathways that are implicated in neuronal dysfunction and can safely perform…
Double lumen endotracheal tubes (DLTs) are considered the gold standard for lung isolation – a procedure where we selectively ventilate a single lung or lobe. This is necessary to “protect” healthy lung tissue from hemorrhage or infection, isolate a bronchopleural fistula, perform unilateral lung lavage, or facilitate video-assisted thoracoscopic surgeries.
Over a dozen different aortic arch great vessel configurations have been described in humans. I’ve illustrated the two most common types in this diagram. The “normal” aortic arch gives rise to three “great vessels.” From proximal to distal, these arteries are the innominate (which, in turn, gives rise to the…
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…