Document Detail


Transesophageal echocardiography in ross procedure.
MedLine Citation:
PMID:  21596194     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: Ross procedure is one of the surgical procedures for correction of severe congenital aortic insufficiency. Intraoperative transesophageal echocardiography is essential for optimal surgical evaluation. Furthermore, it is able to assess the blood volume profile and the need for administration of vasoactive drugs during surgery.
CASE REPORT: This is a 15-year old teenager with severe congenital aortic insufficiency scheduled for corrective surgery with the Ross procedure. In the operating room, the patient was monitored with electrocardiography and pulse oximeter, and he was premedicated with midazolam. After the administration of premedication, the left radial artery and right subclavian vein were punctured. Anesthetic induction was accomplished with etomidate, cisatracurium, and fentanyl while maintenance was achieved with sevoflurane. The probe of the transesophageal echocardiography equipment was introduced immediately after tracheal intubation, showing increased left ventricle; severe aortic insufficiency due to coaptation failure of the three leaflets; and competent pulmonary valve without anatomical and physiological changes. Intercurrences were not observed during surgery, with 120 minutes of extracorporeal circulation (ECC) and 8 hours of surgery. Immediately after removal from ECC the transesophageal echocardiography showed good function of both the auto- and homograft; however, the right ventricle presented hypocontractility, which was corrected with a bolus of milrinone followed by continuous infusion. The patient was transferred to the postanesthetic recovery unit intubated and hemodynamically stable with infusion of milrinone and sodium nitroprusside.
CONCLUSIONS: Ross procedure is one of the techniques for correction of congenital aortic insufficiency in which transesophageal echocardiography guides the surgeon precisely on the physiological and anatomical status of vascular grafts.
Authors:
Marcello Fonseca Salgado Filho; Arthur Siciliano; Luiz Antônio Diego; Leonardo Augusto Miana; Júlia Salgado
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Revista brasileira de anestesiologia     Volume:  61     ISSN:  1806-907X     ISO Abbreviation:  Rev Bras Anestesiol     Publication Date:    2011 May-Jun
Date Detail:
Created Date:  2011-05-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401316     Medline TA:  Rev Bras Anestesiol     Country:  Brazil    
Other Details:
Languages:  eng     Pagination:  344-50     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Editora Ltda. All rights reserved.
Affiliation:
Health from Universidade Federal de Juiz de Fora (UFJF); Anesthesiologist of Instituto Nacional de Cardiologia/MS, Professor of Anesthesiology of UNIPAC-JF.
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