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CA125: a new biomarker in patients with Fontan circulation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:112-120. [PMID: 35870779 DOI: 10.1016/j.rec.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/17/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES Patients with Fontan circulation (FC) have a high incidence of clinical complications. However, no biomarker is able to accurately stratify risk. The aim of this study was to analyze the relationship between biomarkers and clinical complications, including carbohydrate antigen 125 (CA125) for the first time, and to propose a risk estimation based on a combination of biomarkers. METHODS Cross-sectional study of patients with FC. The clinical endpoint was the combination of heart failure, atrial arrhythmias, veno-venous fistulae, protein-losing enteropathy, or plastic bronchitis. Demographic, clinical, and laboratory variables were analyzed, including CA125, NT-proBNP, renal and liver function, and red cell distribution width (RDW). We performed univariate and multivariate analyses of the relationship between these variables and the composite endpoint. Cutoff values were calculated by ROC curves. RESULTS We included 56 patients (27.4±7.8 years). A total of 34% showed the composite endpoint, with significantly higher CA125 levels (30.1 IU/mL vs 12.6 IU/mL; P=.001). In the multivariate model, the biomarkers related to the endpoint were LnCA125 (OR, 5.1; 95%CI, 1.2-22), RDW (OR, 1.8; 95%CI, 1.1-3.1), and FIB4 (OR, 38, 95%CI, 1.7-855). The cutoff points were CA125 ≥ 20 U/mL, FIB4 ≥ 0.75, and RDW ≥ 14.5%, and the probability of the occurrence of the endpoint was 81% if ≥ 2 biomarkers were elevated. CONCLUSIONS CA125 elevation is associated with a higher prevalence of complications in patients with Fontan-type circulation. CA125 levels ≥ 20U/mL, FIB4 ≥ 0.75 and RDW ≥ 14.5% identify with a high probability the clinical failure of FC.
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Muacevic A, Adler JR. Anesthetic Management of a Down Syndrome Patient for Ventricular Septal Defect Repair: A Case Report. Cureus 2023; 15:e34132. [PMID: 36843750 PMCID: PMC9947867 DOI: 10.7759/cureus.34132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
It is commonly known that Down syndrome (DS) and congenital cardiovascular abnormalities go hand in hand. Most frequently, complete atrioventricular septal abnormalities have been linked to DS. Along with DS, ventricular septal defect (VSD), atrial septal defect, tetralogy of Fallot, and patent ductus arteriosus have also been reported. We present a case of DS with VSD who underwent VSD correction. Echocardiography prompted the diagnosis, which was then confirmed by surgery. The patient was successfully transferred out of the hospital. After correcting the VSD, the survival and quality of life of the DS patient have improved.
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Affiliation(s)
- Alexander Muacevic
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - John R Adler
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Buendía Fuentes F, Jover Pastor P, Arnau Vives MÁ, Lozano Edo S, Rodríguez Serrano M, Aguero J, Osa Sáez A, Conde Amiel I, Aguilera Sancho-Tello V, Martínez-Dolz L, Rueda Soriano J. CA125 como nuevo biomarcador en pacientes con circulación de Fontan. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Richter EW, Sniecinski RM, Sumler ML. Echocardiographic Assessment of Ventricular Septal Defects. A A Pract 2020; 14:31-34. [PMID: 31688029 DOI: 10.1213/xaa.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ellen W Richter
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
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Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, Roberson DA, Mercer-Rosa L, Miller OI, Parra DA, Burch T, Carron HD, Wong PC. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic. J Am Soc Echocardiogr 2019; 32:173-215. [DOI: 10.1016/j.echo.2018.08.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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6
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Kuroda M, Maeda T, Usuda I, Mita N, Kagaya S, Miyoshi S, Saito S, Yamashiro M. Utility of Combined Assessment With 2- and 3-Dimensional Transesophageal Echocardiography for Acommissural Unicuspid Pulmonic Valve With Severe Pulmonic Valve Stenosis. A A Pract 2018; 11:230-232. [PMID: 29738330 DOI: 10.1213/xaa.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Masataka Kuroda
- From the Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takayasu Maeda
- Departments of Anesthesiology, Respiratory Center, Kumagaya, Japan
| | - Iwao Usuda
- Departments of Anesthesiology, Respiratory Center, Kumagaya, Japan
| | - Norikatsu Mita
- Departments of Anesthesiology, Respiratory Center, Kumagaya, Japan
| | - Shin Kagaya
- Departments of Anesthesiology, Respiratory Center, Kumagaya, Japan
| | - Sohtaro Miyoshi
- Departments of Anesthesiology, Respiratory Center, Kumagaya, Japan
| | - Shigeru Saito
- From the Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahito Yamashiro
- Surgery, Cardiovascular Division, Saitama Prefectural Cardiovascular and Respiratory Center, Kumagaya, Japan
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Miles LF, Banyasz D, Ip S, Matalanis G. Perimembranous Ventricular Septal Defect Complicated by Aorto-Right Ventricular Fistula: The Role of Multimodal Echocardiography. Anesth Analg 2017; 125:413-416. [PMID: 28107272 DOI: 10.1213/ane.0000000000001876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lachlan F Miles
- From the *Department of Anaesthesia, Austin Health, Heidelberg, Australia; and †Department of Cardiac Surgery, Austin Health, Melbourne, Australia
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8
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Kulkarni KR, Patil MR, Shirke AM, Jadhav SB. Perioperative respiratory complications in cleft lip and palate repairs: An audit of 1000 cases under 'Smile Train Project'. Indian J Anaesth 2014; 57:562-8. [PMID: 24403615 PMCID: PMC3883390 DOI: 10.4103/0019-5049.123328] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Aim: Anaesthesia for cleft surgery in children is associated with a variety of airway related problems. This study aims to review the frequency of associated anomalies and other conditions as well as perioperative respiratory complications during the cleft lip/palate repair surgeries. Methods: An audit of 1000 cleft surgeries in children enrolled under “Smile Train” is presented. Following informed consent, general anaesthesia was induced with endotracheal (ET) intubation using halothane in O2 and/or intravenous thiopentone 5 mg/kg or propofol 1.5 mg/kg, suxamethonium 1.5 mg/kg or rocuronium 0.8 mg/kg and maintained with halothane/isoflurane 0.4-1% in 50% N2O in O2 with rocuronium. The observational data regarding the occurrence of perioperative complications in 1000 cleft surgeries are mentioned as mean (standard deviation), number and percentage as appropriate. ‘Two sample t-test between percentage’ is applied for significance. Results: The frequency of isolated cleft lip was 263 (36.4%), cleft palate 183 (25.3%) and combined defect 277 (38.3%) of the operated cases. Other congenital anomalies were present in 21 (2.8%) of the children. The intraoperative airway complications occurred in 13 (2.4%) of cleft lip and 40 (8.7%) of cleft palate repairs (P < 0.05). Post-operative respiratory complications were observed in 9 (1.7%) and 34 (7.4%) patients of cleft lip and palate repairs respectively (P < 0.05). Mortality occurred post-operatively in 2 (0.2%) of cleft repairs (n = 1000). Conclusion: Cleft deformities in children when associated with other congenital anomalies or respiratory problems pre-dispose them to difficult airway and pulmonary complications. Frequency of perioperative respiratory complications were significantly higher with cleft palate repair than with cleft lip repair. Anaesthetic expertise, optimum monitoring facility and specialised post-operative care is necessary to decrease the morbidity.
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Affiliation(s)
- Kalpana R Kulkarni
- Department of Anaesthesiology and Critical Care, Lotus Hospital and Research Center, Kolhapur, Maharashtra, India
| | - Mohan R Patil
- Department of Anaesthesiology and Critical Care, Lotus Hospital and Research Center, Kolhapur, Maharashtra, India
| | - Abasaheb M Shirke
- Department of Anaesthesiology and Critical Care, Lotus Hospital and Research Center, Kolhapur, Maharashtra, India
| | - Shivaji B Jadhav
- Department of Anaesthesiology and Critical Care, Lotus Hospital and Research Center, Kolhapur, Maharashtra, India
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Nowitz A. Acute Ascending Aortic Dissection 41 Years After Mustard Procedure. J Cardiothorac Vasc Anesth 2013; 27:735-9. [DOI: 10.1053/j.jvca.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Indexed: 11/11/2022]
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Inoue H, Tokita T, Tohi Y, Ito J, Uchida H. Echo rounds: transesophageal echocardiographic imagings of endovascular stent placement for the treatment of aortic coarctation with bicuspid aortic valve. Anesth Analg 2013; 117:579-582. [PMID: 23835451 DOI: 10.1213/ane.0b013e31829c3b06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hiroshi Inoue
- From the Department of Anesthesia, Sendai Kousei Hospital, Miyagi, Japan
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Mossad EB, Motta P, Vener DF. Anesthetic considerations for adults undergoing fontan conversion surgery. Anesthesiol Clin 2013; 31:405-419. [PMID: 23711650 DOI: 10.1016/j.anclin.2012.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There are currently in North America more adults with congenital heart disease than children. This article discusses the anesthetic considerations in adults with single-ventricle physiology and prior repairs who present for Fontan conversion surgery as a demonstration of the challenges of caring for adults undergoing interventions for the repair of congenital heart defects. The care of these patients requires an understanding of the impact of passive pulmonary blood flow and single systemic ventricular physiology. The perioperative morbidity in this patient population remains high.
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Comparative effects of surgical and percutaneous repair on P-wave and atrioventricular conduction in patients with atrial septal defect--ostium secundum type. Cardiol Young 2013; 23:132-7. [PMID: 22475241 DOI: 10.1017/s1047951112000418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both surgical and percutaneous closures of atrial septal defects have been successful in reversal of atrial dilatation. We compared the effects of surgical and percutaneous transvenous device closure of atrial septal defect on post-operative changes of P-wave duration, PR segment, and PR interval. Electrocardiographic data were prospectively collected from 30 patients following either surgical (n equal to 16) or percutaneous (n equal to 16) repair of atrial septal defects between 2004 and 2010. A cardiologist blinded to the closure technique performed the electrocardiographic analyses. P-wave duration (98.5 plus or minus 15.4 to 86.4 plus or minus 13.2 milliseconds, p-value less than 0.05) and PR interval (162.9 plus or minus 18.5 to 140.6 plus or minus 15.2 milliseconds, p-value less than 0.05) were reduced after percutaneous transvenous device closure. P-wave duration (104.5 plus or minus 24.7 versus 83.2 plus or minus 13.3 milliseconds, p-value less than 0.05) and PR interval (173.2 plus or minus 38.7 versus 144.3 plus or minus 32.0 milliseconds, p-value less than 0.05) were also reduced after surgical closure. PR segment in the percutaneous group was significantly reduced (63.4 plus or minus 14.5 to 52.1 plus or minus 10.8 milliseconds, p-value less than 0.05), but not in the surgical group (68.6 plus or minus 18.7 versus 61.1 plus or minus 24.7 milliseconds). However, the difference in PR segment changes between the two groups was not significant (-11.3 plus or minus 15.0 versus -7.6 plus or minus 20.5 milliseconds, p-value equal to 0.18). Our analysis demonstrates that the changes between the two groups were not different and that both closure techniques reduce P-wave duration, PR segment, and PR interval within 6 months.
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Abstract
Transesophageal echocardiography (TEE) plays an important role in the anatomical, functional, and hemodynamic assessment of patients with congenital heart disease (CHD). This imaging approach has been applied to both children and adults with a wide range of cardiovascular malformations. Extensive clinical experience documents significant contributions, particularly in the perioperative setting. In fact, in the current medical era, many consider this technology to be an essential adjunct to surgical and anesthetic management in CHD. This review focuses on the applications of TEE in patients with tetralogy of Fallot (TOF), the most common form of cyanotic heart disease. Emphasis is given to the perioperative use of this imaging modality and benefits derived during the prebypass and postbypass periods. Limitations and pitfalls relevant to the TEE assessment in patients with this anomaly are also addressed.
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Wally D, Knotzer H, Kilo J, Stadlbauer KH, Kolbitsch C, Velik-Salchner C. The Eustachian Valve as a Pitfall in Persistent Foramen Ovale and Atrial Septum Defect Closure. J Cardiothorac Vasc Anesth 2011; 25:680-2. [DOI: 10.1053/j.jvca.2010.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Indexed: 12/21/2022]
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15
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Gologorsky E, Giquel J, Gologorsky A. A silent patent ductus arteriosus: a culprit or an innocent bystander? World J Pediatr Congenit Heart Surg 2011; 2:129-32. [PMID: 23804944 DOI: 10.1177/2150135110386250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 4-mm patent ductus arteriosus (PDA) was serendipitously diagnosed during intraoperative transesophageal echocardiography for a noncardiac procedure in an obese adult patient with a history of decreased exercise tolerance and dyspnea, despite a negative preoperative transthoracic examination. This uncommon event poses questions regarding the relevance of this finding to the differential diagnosis of dyspnea in an obese adult with a negative transthoracic echocardiography study, given the unknown prevalence of this pathology and the absence of consensus regarding the clinical management.
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Affiliation(s)
- Edward Gologorsky
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida
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Gologorsky E, Gologorsky A, Giquel J, Rodriguez YF, Rosenkranz ER, Ricci M. An Adult Patient with Congenitally Corrected Transposition of the Great Arteries. Anesth Analg 2010; 111:1122-4. [DOI: 10.1213/ane.0b013e3181f24418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Three-Dimensional Transesophageal Echocardiography Is a Major Advance for Intraoperative Clinical Management of Patients Undergoing Cardiac Surgery. Anesth Analg 2010; 110:1548-73. [DOI: 10.1213/ane.0b013e3181d41be7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Transesophageal echocardiography images of dynamic subpulmonic left ventricular outflow obstruction in an adult patient after a remote senning procedure for d-transposition of great arteries. Anesth Analg 2010; 111:71-3. [PMID: 20418536 DOI: 10.1213/ane.0b013e3181db7973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ebstein anomaly of the tricuspid valve, atrial septal defect, and severe right ventricular dysfunction in an adult: transesophageal echocardiographic images. Anesth Analg 2010; 110:719-20; discussion 721. [PMID: 20042447 DOI: 10.1213/ane.0b013e3181cb3f1b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Desjardins G, Cahalan M. The impact of routine Trans-oesophageal Echocardiography (TOE) in cardiac surgery. Best Pract Res Clin Anaesthesiol 2009; 23:263-71. [DOI: 10.1016/j.bpa.2009.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Acute right ventricular (RV) failure has until recently received relatively little attention in the cardiology, critical care or anaesthesia literature. However, it is frequently encountered in cardiac surgical cases and is a significant cause of mortality in patients with severe pulmonary hypertension who undergo non-cardiac surgery. RV dysfunction may be primarily due to impaired RV contractility, or volume or pressure overload. In these patients, an increased pulmonary vascular resistance (PVR) or a decreased aortic root pressure may lead to RV ischaemia, resulting in a rapid, downward haemodynamic spiral. The key aspects of 'RV protection' in patients who are at risk of perioperative decompensation are prevention, detection and treatment aimed at reversing the underlying pathophysiology. Minimising PVR and maintaining systemic blood pressure are of central importance in the prevention of RV decompensation, which is characterised by a rising central venous pressure and a falling cardiac output. Although there are no outcome data to support any therapeutic strategy for RV failure when PVR is elevated, the combination of inhaled iloprost or intravenous milrinone with oral sildenafil produces a synergistic reduction in PVR, while sparing systemic vascular resistance. Levosimendan is a promising new inotrope for the treatment of RV failure, although its role in comparison to older agents such as dobutamine, adrenaline and milrinone has yet to be determined. This is also the case for the use of vasopressin as an alternative pressor to noradrenaline. If all else has failed, mechanical support of the RV should be considered in selected cases.
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Affiliation(s)
- P Forrest
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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George L. Review of intraoperative TOE. Australas J Ultrasound Med 2009; 12:30-36. [PMID: 28191053 PMCID: PMC5024836 DOI: 10.1002/j.2205-0140.2009.tb00051.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Lenore George
- Department of Anaesthesia Westmead Hospital Sydney New South Wales 2145 Australia
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Affiliation(s)
- Denise C Joffe
- Department of Anesthesiology,University of Washington Medical Center, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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Parnell AD, Wilkinson GAL, Morgan-Hughes NJ. Ventriculoseptal defect detected after surgical repair of double-chamber right ventricle. Anesth Analg 2008; 106:1385-6. [PMID: 18420848 DOI: 10.1213/ane.0b013e3181684153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alison D Parnell
- Department of Anaesthesia and Critical Care, Northern General Hospital, Sheffield, UK.
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Patel K, Shankar V, Plambeck CJ, Pagel PS. Progressive dyspnea and exercise intolerance in an adult with a persistent childhood murmur. J Cardiothorac Vasc Anesth 2008; 22:157-9. [PMID: 18249353 DOI: 10.1053/j.jvca.2007.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Kishan Patel
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
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Neuman MD, Fox JA, Muehlschlegel JD. Incidental discovery of a large patent ductus arteriosus in an adult during aortic reconstruction: echocardiographic findings and diagnostic dilemmas. Anesth Analg 2007; 105:1227-8. [PMID: 17959946 DOI: 10.1213/01.ane.0000282828.13598.2e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark D Neuman
- Brigham and Women's Hospital, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston, Massachusetts 02115, USA
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Cattano D, Nicolini A, Genovesi M, Buzzigoli S. Laparoscopic Cholecystectomy in an Adult with Complex-Corrected Congenital Heart Disease. Anesth Analg 2007; 104:242-3. [PMID: 17179317 DOI: 10.1213/01.ane.0000252111.58241.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Anesthesia for adults with congenital heart disease has many challenging physiologic considerations. Collaborative relationships of a multidisciplinary team including cardiology, cardiac surgery, anesthesiology, and intensive care are essential to ensure positive outcomes in this population for noncardiac and cardiac surgery.
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Affiliation(s)
- Jane Heggie
- Department of Anesthesia, Toronto General Hospital, 3 Eaton North, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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