cardiothoracic

The Heart’s Fibrous Skeleton

There’s a complex yet beautiful architecture within the heart's fibrous skeleton and valvular geometry. To become a proficient perioperative echocardiographer, one must understand these spatial relationships in three dimensions and the implications that specific...

Left Ventricular Pressure-Volume Work Loop With Mechanical Circulatory Support

Mechanical circulatory support (MCS) devices allow us to offload myocardial work from the heart, and for the purposes of this post, the left ventricle (LV). Referring to my previous post on the work of...

Starling Equation – Hydrostatic and Oncotic Pressures

"Starling forces" describe the movement across capillaries as a balance between hydrostatic and oncotic pressure gradients within the capillary and in the surrounding interstitium. Filtration across the capillary membrane occurs along its entire length...

Systolic Anterior Motion (SAM) Of The Mitral Valve – Left Ventricular Outflow Tract (LVOT) Obstruction

Left ventricular outflow tract (LVOT) obstruction is a potentially catastrophic etiology for hypotension due to several etiologies: idiopathic hypertrophic subaortic stenosis (IHSS), hypertrophic obstructive cardiomyopathy (HOCM), systolic anterior motion (SAM) of the mitral valve,...

Surgical Steps In Bilateral Lung Transplantation

A standard double lung transplantation includes a series of steps involving incision (median sternotomy or clamshell thoracotomy), cardiopulmonary bypass (CPB) in many cases, right and left pneumonectomies of the native lungs, preparation of the...

What Is Pleurodesis?

Pleurodesis is a procedure aimed to obliterate the intrapleural space in patients with recurrent malignant/non-malignant effusions and recurrent pneumothorax. In mechanical pleurodesis, surgeons will usually perform a video-assisted thoracoscopic surgery (VATS), identify the parietal pleura, and...

What Is An Impella?

Impella® is a percutaneous axial heart pump placed retrograde across the aortic valve into the left ventricle (LV) utilizing fluoroscopy +/- echocardiography. Its indications include high-risk percutaneous coronary intervention (PCI, especially cardiogenic shock or...

What Is Cardiopulmonary Bypass (CPB)

This post outlines the steps in traditional, central cannulation for cardiopulmonary bypass (CPB). Depending on the nature of the surgery and the patient's comorbidities, other sites are often cannulated (left heart bypass, femoral-femoral peripheral...

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