Medical Pharmacology Chapter 43:  Adult Cardiac Procedures

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 Valvular Disease and Ventricular Function Analysis

  • Radionuclide  Angiocardiography

    • Pulmonary vascular anomalies, such as pulmonary emboli

    • Rationale for imaging to detect pulmonary emboli

    • Pulmonary emboli common (25-50,000 deaths per year; 25 percent autopsy incidence)

    • Most reliable signs: sudden dyspnea/hypoxemia [less reliable signs: sub-sternal pressure; hemoptysis; pleuritic pain]

    • Pulmonary emboli: maybe lethal, but treatable

    • Imaging techniques confirm clinical sign and screen high-risk patients

    • Diagnostic methodology: 

    • Nuclear medicine (isotope tagging) Ventilation/Perfusion Scan (V/Q)

    • Based on IV injection of isotope-tagged microspheres, which "embolize" an  insignificant number of capillaries-- as a result "MAP PERFUSION"

    • Ventilation images are obtained by patient inhalation of radioactive Xe 133

    • Ventilation images and perfusion images are then compared

      • Normal pulmonary ventilation Corresponding abnormal perfusion image
        • The presence of several large focal perfusion defects not managed by ventilation defects indicates a high probability of pulmonary embolism.

          • Images courtesy of Creighton University School of Medicine, Special Pulmonary Imaging

  • Electron Beam Tomography

    • Electron beam capture  tomography and visualization of pulmonary emboli (yellow arrows); images courtesy of Dr. Patrick Sheedy, Mayo Clinic, MN


      • Electron Beam Tomography: Pulmonary Emboli (images courtesy of Imatron )

  • Primary Reference:  Ross, AF, Gomez, MN. and Tinker, JH Anesthesia for Adult Cardiac Procedures in  Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 1659-1698, 1998.

  • Primary Reference: Shanewise, JS and Hug, Jr., CC, Anesthesia for Adult Cardiac Surgery, in Anesthesia, 5th edition, vol 2, (Miller, R.D, editor; consulting editors, Cucchiara, RF, Miller, Jr.,ED, Reves, JG, Roizen, MF and Savarese, JJ) Churchill Livingston, a Division of Harcourt Brace & Company, Philadelphia, pp. 1753-1799, 2000.

  • Primary Reference: Wray Roth, DL, Rothstein, P and Thomas, SJ Anesthesia for Cardiac Surgery, in Clinical Anesthesia, third edition  (Barash, PG, Cullen, BF, Stoelting, R.K, eds), Lippincott-Raven Publishers, Philadelphia, pp. 835-865, 1997.



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