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Matsumura K, Maeda T, Kotoku A, Onishi Y. Usefulness of Transesophageal Echocardiography in Diagnosing the Cause of Circulatory Collapse During Reoperation for an Inferior Vena Cava-Left Atrium Shunt After Atrial Septal Defect Closure: A Case Report. A A Pract 2024; 18:e01818. [PMID: 39066688 DOI: 10.1213/xaa.0000000000001818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Iatrogenic inferior vena cava (IVC)-left atrium (LA) shunt is a rare complication in atrial septal defect (ASD) surgery, caused by mistaking the Eustachian valve for the lower margin of the ASD. In this report, we describe the case of a 45-year-old woman who experienced circulatory collapse at termination of cardiopulmonary bypass during surgical IVC-LA shunt repair. Transesophageal echocardiography helped identify stenosis between the IVC and the right atrium, caused by a residual original incorrectly placed ASD patch. Removal of most of the patch led to improvement in circulatory failure.
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Affiliation(s)
- Kaori Matsumura
- From the Department of Anesthesiology, Osaka General Medical Center, Osaka, Japan
| | | | - Akiyuki Kotoku
- Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Onishi
- Department of Anesthesiology, The Sakakibara Heart Institute of Okayama , Japan
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2
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Stoklosa K, Dvirnik N, Cusimano RJ. Modified autotransplantation technique for surgical resection of complex pericardial synovial sarcoma. J Card Surg 2022; 37:1445-1449. [PMID: 35254688 DOI: 10.1111/jocs.16360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Technical details for complex cardiac tumor resection are sparse. We describe the operative technique of modified autotransplantation for resection of a complex pericardial synovial sarcoma in a 63-year-old, Caucasian female. Surgical exposure demonstrated tumor origin at the superior cavoatrial junction and invasion of the aorta, main pulmonary artery, superior pulmonary veins, and left atrial roof. Full macroscopic surgical resection was achieved. The patient received adjuvant radiation for microscopic positive margins and remains alive and with no tumor progression at one year postoperatively. We conclude that modified autotransplantation is a challenging but effective surgical technique when performed with careful patient selection and availability of skilled, cardiothoracic surgeons at a cardiac center of excellence.
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Affiliation(s)
- Klaudiusz Stoklosa
- Faculty of Medicine, University of Toronto Medical School, Toronto, Ontario, Canada
| | - Nazari Dvirnik
- Division of Cardiac Surgery, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Cusimano
- Division of Cardiac Surgery, University Health Network-Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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3
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Denault AY, Roberts M, Cios T, Malhotra A, Paquin SC, Tan S, Cavayas YA, Desjardins G, Klick J. Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach. Anesth Analg 2021; 133:630-647. [PMID: 34086617 DOI: 10.1213/ane.0000000000005537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The use of transesophageal echocardiography (TEE) in the operating room and intensive care unit can provide invaluable information on cardiac as well as abdominal organ structures and function. This approach may be particularly useful when the transabdominal ultrasound examination is not possible during intraoperative procedures or for anatomical reasons. This review explores the role of transgastric abdominal ultrasonography (TGAUS) in perioperative medicine. We describe several reported applications using 10 views that can be used in the diagnosis of relevant abdominal conditions associated with organ dysfunction and hemodynamic instability in the operating room and the intensive care unit.
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Affiliation(s)
- André Y Denault
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Michael Roberts
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Theodore Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Milton S. Hershey Penn State Medical Center, Penn State University School of Medicine, Hershey, Pennsylvania
| | - Anita Malhotra
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Sarto C Paquin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM)
| | - Stéphanie Tan
- Department of Radiology, Montreal Heart Institute, Université de Montréal
| | - Yiorgos Alexandros Cavayas
- Department of Medicine and Intensive Care Unit, Montreal Sacré-Coeur Hospital and Department of Medicine and Intensive Care Unit, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- From the Department of Anesthesiology and Critical Care Medicine, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - John Klick
- Department of Anesthesiology, University of Vermont Medical Center, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Abudan A, Kidd B, Hild P, Gupta B. Obstruction of the inferior vena cava following bicaval orthotopic heart transplantation: a case series. Eur Heart J Case Rep 2021; 5:ytab046. [PMID: 33738420 PMCID: PMC7954254 DOI: 10.1093/ehjcr/ytab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/27/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Inferior vena cava (IVC) obstruction is a rare complication of orthotopic heart transplantation (OHT) and is unique to bicaval surgical technique. The clinical significance, diagnosis, complications, and management of post-operative IVC anastomotic obstruction have not been adequately described. CASE SUMMARY Two patients with end-stage heart failure presented for bicaval OHT. Post-operative course was complicated with shock refractory to fluid resuscitation and inotropic/vasopressor support. Obstruction at the IVC-right atrial (RA) anastomosis was diagnosed on transoesophageal echocardiography (TOE), prompting emergent reoperation. In both cases, a large donor Eustachian valve was found to be restricting flow across the IVC-RA anastomosis. Resection of the valve resulted in relief of obstruction across the anastomosis and subsequent improvement in haemodynamics and clinical outcome. DISCUSSION Presumably rare, we present two cases of IVC obstruction post-bicaval OHT. Inferior vena cava obstruction is an under-recognized cause of refractory hypotension and shock in the post-operative setting. Prompt recognition using TOE is crucial for immediate surgical correction and prevention of multi-organ failure. Obstruction can be caused by a thickened Eustachian valve caught in the suture line at the IVC anastomosis, which would require surgical resection.
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Affiliation(s)
- Anas Abudan
- Department of Medicine, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Brent Kidd
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Peter Hild
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
| | - Bhanu Gupta
- Department of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA
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Adesokan AI, McCheyne A, Crossland DS. IVC Stent to Improve Ventricular Assist Device Filling Following Pediatric Cardiac Transplant. World J Pediatr Congenit Heart Surg 2020; 11:512-514. [PMID: 32645764 DOI: 10.1177/2150135120908184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor ventricular assist device filling is often seen in patients supported with the Berlin Heart Excor. Caval stenosis is an uncommon complication following the bicaval approach to orthotopic heart transplantation. We report the case of a five-year-old female patient post heart transplantation whose poor right ventricular assist device filling immediately resolved following management of caval stenosis.
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Affiliation(s)
- Akintayo I Adesokan
- Department of Pediatric Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Alan McCheyne
- Department of Cardiothoracic Anesthesia, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - David S Crossland
- Department of Pediatric Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom.,Cardiovascular Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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Nicoara A, Skubas N, Ad N, Finley A, Hahn RT, Mahmood F, Mankad S, Nyman CB, Pagani F, Porter TR, Rehfeldt K, Stone M, Taylor B, Vegas A, Zimmerman KG, Zoghbi WA, Swaminathan M. Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2020; 33:692-734. [PMID: 32503709 DOI: 10.1016/j.echo.2020.03.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount. Equally important is the need for complete understanding of the technical steps of the surgical procedures being performed and the complications that may occur, in order to direct the postprocedure evaluation toward aspects directly related to the surgical procedure and to provide pertinent echocardiographic information. The rationale for this document is to outline a systematic approach describing how to apply the existing guidelines to questions on cardiac structure and function specific to the intraoperative environment in open, minimally invasive, or hybrid cardiac surgery procedures.
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Affiliation(s)
| | | | - Niv Ad
- White Oak Medical Center and University of Maryland, Silver Spring, Maryland
| | - Alan Finley
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Bradley Taylor
- University of Maryland Medical Center, Baltimore, Maryland
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Essandoh M, Whitson BA. Caval Stenosis After Bicaval Orthotopic Heart Transplantation: Routine Transesophageal Echocardiography Assessment of the Caval Anastomoses May Avert This Complication. J Cardiothorac Vasc Anesth 2019; 34:568-569. [PMID: 31416675 DOI: 10.1053/j.jvca.2019.07.140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 07/19/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Essandoh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Bryan A Whitson
- Division of Cardiac Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
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Tan Z, Roscoe A, Rubino A. Transesophageal Echocardiography in Heart and Lung Transplantation. J Cardiothorac Vasc Anesth 2019; 33:1548-1558. [DOI: 10.1053/j.jvca.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 02/04/2023]
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9
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Abrams B, Hoffman J, Aftab M, Evers J, Seres T. A Rare Case of Stenosis at the Inferior Vena Cava to Right Atrium Anastomosis After Bicaval Orthotopic Heart Transplantation. Semin Cardiothorac Vasc Anesth 2019; 23:418-421. [DOI: 10.1177/1089253219832608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stenosis at either the superior or inferior caval anastomosis is a rare complication of orthotopic heart transplantation (OHT) and is unique to the bicaval surgical technique. The severity of stenosis dictates the degree of clinical significance, varying from asymptomatic to congestive end-organ injury and hemodynamic instability from impaired preload. Due to differences in the anatomic location of organ congestion, the clinical presentation also depends on which of the 2 anastomoses is involved. In this article, the authors describe a case of stenosis at the inferior vena cava to right atrium anastomosis, which was diagnosed intraoperatively during OHT after weaning from cardiopulmonary bypass. Transesophageal echocardiography provided an accurate and timely diagnosis of this complication, which allowed for immediate surgical correction. Surprisingly, a large, native Eustachian valve was found to be obstructing the anastomosis. Resection of the valve relieved the previously significant narrowing across the anastomosis. This case highlights the importance of thorough intraoperative transesophageal echocardiographic evaluation of graft anastomoses during OHT, as well as an understanding on the part of the echocardiographer of the specific surgical techniques employed during OHT.
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Chaney MA, Lowe ME, Minhaj MM, Santise G, Jacobsohn E. Inferior Vena Cava Stenosis After Bicaval Orthotopic Heart Transplantation. J Cardiothorac Vasc Anesth 2019; 33:2561-2568. [PMID: 31142438 DOI: 10.1053/j.jvca.2019.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
| | - Michael E Lowe
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mohammed M Minhaj
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Gianluca Santise
- Department of Cardiac Surgery, Sant'Anna Hospital, Catanzaro, Italy
| | - Eric Jacobsohn
- University of Manitoba, Health Sciences Centre, Winnipeg, Manitoba, Canada
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Portran P, Lavigne F, Jacquet-Lagreze M, Fellahi JL. Inferior vena cava stenosis after heart transplant: a rare cause of venoarterial extracorporeal membrane oxygenation weaning failure. Perfusion 2018; 34:254-256. [PMID: 30394852 DOI: 10.1177/0267659118808731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The discontinuation of venoarterial extracorporeal membrane oxygenation (VA ECMO) is a critical step in patient recovery. To reduce risks, weaning trials must be performed to buttress this important decision. However, a successful weaning trial does not preclude the possibility of complications. CASE REPORT Here, we report a case of sudden multiple organ failure in a heart transplant patient, occurring after a successful ECMO weaning trial. We finally diagnosed a rare post-surgical complication of bicaval orthotopic heart transplantation, a severe stenosis of the inferior vena cava (IVC) that had been masked by the post-operative ECMO. DISCUSSION AND CONCLUSION Our case report should serve as a cautionary tale: it may be of interest to add a search for complications at the vascular anastomoses to the weaning trial procedure and to keep an eye out for them in the following days.
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Affiliation(s)
- Philippe Portran
- Service d'Anesthésie et Réanimation du Groupement Hospitalier Est (GESTAR), Hospices Civils de Lyon, Lyon, France
| | - Flavie Lavigne
- Service d'Anesthésie et Réanimation du Groupement Hospitalier Est (GESTAR), Hospices Civils de Lyon, Lyon, France
| | - Matthias Jacquet-Lagreze
- Service d'Anesthésie et Réanimation du Groupement Hospitalier Est (GESTAR), Hospices Civils de Lyon, Lyon, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie et Réanimation du Groupement Hospitalier Est (GESTAR), Hospices Civils de Lyon, Lyon, France
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12
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Farooki AM, Patel PA, Horak J, Weiss SJ. Intraoperative echocardiographic diagnosis of inferior vena cava stenosis after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2013; 28:1310-3. [PMID: 23958075 DOI: 10.1053/j.jvca.2013.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Ali M Farooki
- Department of Anesthesiology and Critical Care, Cardiovascular Division, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA.
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, Cardiovascular Division, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
| | - Jiri Horak
- Department of Anesthesiology and Critical Care, Cardiovascular Division, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Department of Anesthesiology and Critical Care, Cardiovascular Division, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA
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Agnoletti G, Marini D, Bordese R, Villar AM, Gabbarini F. Interventional catheterisation of stenotic or occluded systemic veins in children with or without congenital heart diseases: early results and intermediate follow-up. EUROINTERVENTION 2012; 7:1317-25. [PMID: 22433195 DOI: 10.4244/eijv7i11a207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Limited data exists on midterm results concerning paediatric interventions on stenotic or occluded systemic veins following indwelling lines, cardiac surgery, or catheterisations. The purpose of this study was to report our acute and intermediate results concerning patients with (Group A) and without (Group B) congenital heart diseases (CHD) over a 10-year period. METHODS AND RESULTS From January 2000 to December 2010, 32 patients (23 in Group A and nine in Group B, respectively) underwent 39 interventional catheterisations aimed to dilate or recanalise occluded iliofemoral veins, inferior or superior venae cavae. Initial and follow-up catheterisation data were reviewed retrospectively. Midterm results were evaluated by means of echography, angiography, and CT scan in all 15 and 17 patients, respectively. Median age and weight of all patients at catheterisation were five years (range 0.1-18) and 15 kg (range 2-60), respectively. Fifty-two stents were implanted in 29 patients (32 vessels). In 25 patients 28 vessels were occluded and required recanalisation. There were no major complications. In all but three patients it was possible to treat the lesion. There were two procedural complications (5.1%): one acute stent occlusion and one local dissection. At a median follow-up of 2.5 years (range 1-10) we observed six complications of stenting (11.5%): two fractures, two occlusions and two restenoses. CONCLUSIONS Interventional catheterisation of stenotic or occluded systemic veins grants good immediate results at a low rate of complication. Stent dilatation or recanalisation may open the vessel for use during future procedures. However, long-term results are yet to be established.
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Affiliation(s)
- Gabriella Agnoletti
- Department of Cardiology, Paediatric Hospital Regina Margherita, Turin, Italy.
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Sharma V, Wasowicz M, Brister S, Karski J, Meineri M. Postoperative Transesophageal Echocardiography Diagnosis of Inferior Vena Cava Obstruction After Mitral Valve Replacement. Anesth Analg 2011; 113:1343-6. [DOI: 10.1213/ane.0b013e318232e206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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