Core Topics in Cardiac Anesthesia, Second Edition

Cambridge University Press 978-0-521-19685-7 - Core Topics in Cardiac Anesthesia: Second Edition Edited by Jonathan H. Mackay and Joseph E. Arrowsmith Index More information

Index

abciximab 465–6 airway management, postoperative endocarditis therapy 449 abdominal arteries 79 resuscitation 416 multi-resistant bacteria 450–2 accessory conducting pathways aldosterone 31–2 surgical prophylaxis 246, 342, 362, 9–10 alfentanil 36–7 447–8 acetylcholine (ACh) 25 allograft vasculopathy 280 anticoagulation acid-base management 391, 403–4, allostasis 29 atrial fibrillation 412 441 alpha-1-microalbumin 435 CPB 64–7, 175 actin 13–15 alpha-adrenergic receptors (a-ARs) ECMO 364 action potentials (APs), cardiac 8–11 25, 41, 48 endogenous 367–8 activated clotting time (ACT) 64, 67, alpha-stat blood-gas management 391, intra-aortic balloon pump 357 175, 370 403–4, 441 monitoring 67, 175 activated partial thromboplastin time e-aminocaproic acid (EACA) 68, 69, off-pump coronary surgery (APPT) 67 175, 368 190–1 acute coronary syndromes (ACS) amiodarone 57, 60 preoperative cessation 169 257–60 amitriptyline 463 prosthetic valve recipients 127, anesthetic management 258 Amplatzer muscular VSD 129–30 pathogenesis 257 occluder 264 antidepressants 463 acute kidney injury (AKI) 431–6 Amplatzer septal occluder 262–3 antidiuretic hormone (ADH) 31–2 acute lung injury (ALI) 421 analgesia anti-dysrhythmic drugs 57–62, 256, acute normovolemic hemodilution chronic pain 463 409 (ANH) 372, 468 postoperative 182, 191, 238–9, antifibrinolytics 68–9, 368–9 acute renal failure (ARF) 430–6 460–2 antihypertensives 53–6 acute respiratory distress syndrome anasarca 77 antioxidants 116 (ARDS) 421–3 anatomy, normal 4–6 antiphospholipid syndrome 466–7 adenosine ancrod 66 antiplatelet therapy 169, 465–6 coronary blood flow regulation 24 anemia antithrombin deficiency 467–8 pharmacological use 61 dilutional 176–7, 404–5 aorta adenosine receptors 41 failure to wean from CPB 357 anatomy 223 adhesion molecules 40 anesthetic agents atheroma 440–1 adrenaline see epinephrine cardiac conduction effects cannulation 109, 175–6 adrenoreceptors 48 254–5 clamping, MICS 217–19 see also a-adrenergic receptors; cardiovascular effects 33–7 coarctation 239, 314 b-adrenergic receptors anesthetic preconditioning 122 cross-clamping 109, 113, 233, adult congenital heart disease aneurysms 235–6 (ACHD) 339–43 aortic see aortic aneurysms decannulation 110, 179 anesthetic management 341–2 ventricular 271–2 descending thoracic see descending postoperative care 342–3 angina pectoris 76 thoracic aorta preoperative assessment aortic stenosis 193–4 imaging 91, 93, 441 339–41 CCS scale 76 management during CPB 379 advanced life support (ALS), adult chronic refractory 463–4 traumatic injuries 296–7 413–16 unstable (UA) 257–8 aortic aneurysms afterdrop hypothermia 385, 390 angiotensin II 25–6, 31 aortic arch 228–30 afterload 18–19 angiotensin II receptors 41 descending thoracic aorta post-bypass management 410 Anrep effect 28 232–9 agonists 43–4 antacids, prophylactic 425 etiology 229 air embolism (AE) 355–6, 395–7 antagonists 43–4 aortic arch 228–31 air entrainment antibiotics aneurysms 228–30 482 CPB 398 ARDS therapy 423 surgery 230–1 ECMO 365 endocarditis prophylaxis 448–9 traumatic rupture 228

© in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-19685-7 - Core Topics in Cardiac Anesthesia: Second Edition Edited by Jonathan H. Mackay and Joseph E. Arrowsmith Index More information

Index

aortic dissection 223–7 arterial switch procedure 323 Bjork-Shiley valve 125 classification 223–4 arteries, auscultation 79 Blalock-Taussig (B-T) shunt, modified during CPB 398 artery of Adamkiewicz 237 305, 329–30 descending thoracic aorta 239 aspirin 129–30, 169, 465–6 bleeding see hemorrhage pregnancy 301 asymmetrical septal hypertrophy bleeding tendency, increased 465–6 aortic interruption 314 (ASH) 268–9 blood conservation, perioperative aortic regurgitation (AR) 196–8 atelectasis 420 371–3, 467–8 indications for surgery 104 atherosclerosis 257 blood donation, preoperative non-cardiac surgery 476 ATP 15, 119 autologous (PAD) 372 aortic stenosis (AS) 104, 193–6 atracurium 35 blood flow non-cardiac surgery 476 atrial fibrillation (AF) 12, 250–1 effects of CPB 71 percutaneous interventions 262, 264 electrophysiological interventions inadequate, during CPB 398 pregnancy 300 253, 255 metabolic control 24, 29 aortic syndrome 232 mitral valve disease 202, 207 myogenic control 25–6, 29 aortic valve (AV) 193 postoperative 411–12, 441 velocity, measurement 148–9 disease 193–9 atrial flutter 251 blood-gas management 391, 403–4, orifice area (AVA) 193, 195 atrial natriuretic peptide (ANP) 31, 32, 441 transcatheter implantation (TAVI) 434 blood loss, postoperative 183–4, 264–6 atrial septal defects (ASDs) 315–16 335 aortic valve surgery 110 percutaneous closure 262–3 blood pressure (BP) anesthetic management 195–6, 198 atrioventricular (A-V) canal 2 control, aortic dissection 226 indications 104 atrioventricular node (AVN) 9 invasive monitoring 141–3 Ross procedure 127, 333–4 atrioventricular septal defect non-invasive monitoring 136–7 aortic valvuloplasty, balloon 262 (AVSD) 318–19 pediatric patients 303 aortography 97, 100, 229 auscultation 78–80 blood pumps see pumps, blood APJ (apelin) receptors 41 autonomic nervous system (ANS) 29–31 blood transfusion 442 apoptosis 120 coronary blood flow 25 algorithms 371 aprotinin 67–8, 311, 379 efferents 5–6, 30 autologous 372–3 arachidonic acid metabolites 376, 378 heart rate 11 during CPB 404–5 argatroban 65 autoregulation 29 pediatric patients 335 L-arginine 117 cerebral blood flow 161, 400 reduction strategies 222, 371–3 b-arrestin 43–4 coronary blood flow 23, 24–6 blunt chest trauma 293–6 arrhythmias 11–12, 249–52 heterometric 28 Bowditch effect 28–9 adult congenital heart disease 341 homeometric 28 Boyle’s law 396 anesthesia-related 34 AVID mnemonic 176, 177 bradycardia, postoperative 182, electrophysiological interventions 336, 415 252–6 baclofen 463 bradydysrhythmias 252 pediatric patients 336 Bainbridge reflex 31 bradykinin 25 perioperative diagnosis 135–6 baroreceptor reflexes 30–1 brain natriuretic peptide (BNP) post-infarction 258–9 baroreceptors 29 434, 474 postoperative 409 basic life support (BLS), adult 413 breathlessness 194, 203 redo surgery 221 benzodiazepines 35, 73 bretylium 57, 60 weaning from CPB 356 Bernoulli equation 149 bronchus blocker 235 arrhythmogenic right ventricular beta-adrenergic blockers 44 bubble oxygenators 348–9 cardiomyopathy (ARVC) 274 anti-dysrhythmic 57, 59–60 bubble traps, CPB 352–3 arterial blood pressure cardioplegic solutions 116 bulbis cordis 1, 2 during CPB 176 postoperative use 409 bundle of His 10 monitoring 141–3 beta-adrenergic receptor kinase bupivacaine 36 arterial cannulae 352 (b-ARK) 43 buprenorphine 463 arterial cannulation beta-adrenergic receptors (b-ARs) 25, aortic surgery 234 41–2, 48 cesarean section 299 CPB 141–2, 175–6, 215 genetic polymorphisms 43–4 calcium (Ca2þ) ECMO 364 regulation 41–4 cardiac action potential 10–11 arterial elastance (AE) 21 Bezold-Jarisch reflex 31 excitation–contraction coupling arterial injuries, traumatic 296 bi-directional cavopulmonary shunt 15–16 arterial line filters 352–3, 379, 441 331–3 pharmacological use 52, 310, 410 arterial lines, removal 185 BioMedicus® centrifugal blood calcium channel blockers 57, 61 arterial shunt (modified Blalock- pump 347 capsaicin 463 Taussig shunt) 305, 329–30 bivalirudin 65 carbamazepine 463 483

Index

carbon dioxide recipient selection 276–7 cardiotomy reservoir 350–1 operative field insufflation 442 ventricular assist device cardiovascular disease, non-cardiac production 380 explantation 363 surgery 469–77 carcinoid heart disease 212–14 cardiac tumors 288–92 cardiovascular problems, cardiac arrest cardiac veins 6–7 postoperative 409–12 CPB for resuscitation 408 cardiomyopathies 268–74 cardioversion postoperative 413–19 cardioplegia 113–17, 178 DC 253, 256 therapeutic hypothermia 385, cold vs. warm 116, 402 postoperative atrial fibrillation 412 418–19 delivery methods 115–17 cariporide 116–17 traumatic 297 see also resuscitation minimally invasive surgery 217–19 Carney syndrome 288 cardiac catheterization 95–100 redo surgery 221 catecholamines 16, 31, 49–51 cardiac cycle 18, 22 solution components 114–17 catheter laboratory, cardiac arrests cardiac disease cardiopulmonary bypass (CPB) 37, in 418 invasive diagnostic techniques 108–10, 175–80 catheter laboratory procedures 95–101 air embolism 355–6, 395–7 261–7 non-cardiac surgery 469–77 anesthesia during 177–8 anesthesia for 255–6, 266–7 non-invasive diagnostic tests blood-gas management 403–4 occlusion devices 262–4 81–94 cardiovascular management 176–7 percutaneous valve devices 264–6 pregnancy 299–300 coagulation management stenotic lesions 261–2 symptoms and signs 75–80 64–70, 175 celecoxib 463 cardiac failure see heart failure coagulopathy 368–71 cell salvage 373, 441–2, 468 cardiac glycosides 16 controversies 400–5 central venous cannulation 142–3 cardiac masses 288–92 de-airing 110, 178 pacemaker recipients 246 imaging 93 deep hypothermic circulatory arrest pediatrics 309 management 291–2 389–90 central venous pressure (CVP) cardiac myocytes drug pharmacokinetics 71–3 monitoring 142–4, 185 conducting system 8–10 emergencies 395–9 respiratory variation 146 morphology 13–14 equipment 345–54 waveforms 143–4 cardiac output (CO) failure to wean 355–8 centrifugal pumps 347–8 measurement 96, 144, 146, femoro-femoral 406 cerebral artery blood flow velocity 149, 154 flow rate see flow rate, pump (CBFV) 161 during pregnancy 299 glucose management 404 cerebral embolism 439, 441–2 in shock 146 hematocrit during 176–7, 404–5 cerebral function monitoring 163–7 cardiac resynchronization therapy history 108, 345 cerebral oximetry, intraoperative 380 (CRT) 242–3 inadequate flow 398 cerebral perfusion cardiac risk assessment, non-cardiac inadequate oxygenation 397–8 intermittent 392 surgery 469–72 mini circuits 353–4 optimizing 442 cardiac surgery minimally invasive surgery 216–19 retrograde (RCP) 392–3, 396–7 basic principles 108–11 non-cardiac applications 406–8 selective anterograde (SACP) closed, pediatrics 306 normothermia vs. hypothermia 116, 391–3 historical development 108 402, 441 cerebral perfusion pressure (CPP) minimally invasive (MICS) 215–19 off-pump surgery conversion to 191 160–1, 442 myocardial protection 108–9, pacing 178–9 cerebral protection 390–3, 441–4 113–18 pediatrics 309–11 aortic arch surgery 231 new developments 111 pregnancy 301 pediatrics 309 pacemaker/ICD recipients 244–7 pressure vs. flow 400–1 recommendations 444 patient selection 103–4 pulsatile flow 402–3 cerebrospinal fluid (CSF) drainage pregnancy 299–301 pump flow rate see flow rate, pump 237–8 redo 220–2 redo surgery 221 cerebrovascular disease, pre-existing risk assessment 104–6 reducing bleeding/transfusion 440, 477 see also cardiopulmonary bypass; requirements 373 CHARGE association 320 monitoring, perioperative resuscitation using 407–8, 416 Charles’s law 396 cardiac tamponade see tamponade, rewarming 139, 178, 384–5 chemoreceptors 29, 31 pericardial safety features 353 chest compressions 413 cardiac transplantation 275–80 setting up 109, 175–7 chest drains anesthetic management 278–9 systemic inflammatory response removal 185 complications 279–80 374–80 traumatic injuries 293–5 donor selection 277 weaning 179, 219, 309–11 chest pain 76 484 immunosuppression 279–80 see also cardioplegia chest radiography (CXR) 87, 93

Index

chest re-opening, emergency 416–18 coronary arteries 6–7 deep hypothermic circulatory arrest Cheyne-Stokes breathing 78 coronary artery bypass graft (CABG) (DHCA) 387–94 cholecystitis, postoperative 427 surgery 110, 169–92 aortic surgery 231, 234, 388–9 chordae tendinae 4, 200 anesthetic/operating room 170–3 pediatrics 309 chronotropy/chronotrope 30, 48 antibiotic prophylaxis 447 defibrillation 178, 413–15 citalopram 463 early postoperative care 181–5 denervation sensitivity 43 clomethiazole 443 indications 103–4 descending thoracic aorta (DTA) 232–40 clonidine 463 induction and maintenance 171–3 aneurysms 232–9 clopidogrel 465 minimally invasive direct dissection 239 Clostridium difficile-associated (MIDCAB) 187 transection 239 diarrhea 451–2 myocardial protection 116–17 desensitization, receptor 41–3 coagulation neurological complications desflurane 33, 72, 254 management 64–70 439–40 desmopressin (DDAVP) 69 pathways 366–7 off-pump (OPCAB) 110–11, 117, Di George syndrome 308, 320 perioperative tests 368–71 186–92 diabetes mellitus 439–40 coagulopathy 368–71 premedication 170 diaphragmatic injuries 295 pediatric patients 311 preoperative assessment 169–70 diastolic function, regulation 16 see also hemorrhage preparation for anesthesia 170–1 diathermy, pacemaker/ICD coarctation of aorta 239, 314 redo 220–2 recipients 246 codeine 463 vascular access and monitoring diazoxide 55 cold agglutinins 468 170–2 diclofenac 463 communication 175, 182–3 see also cardiopulmonary bypass digoxin 62 complement coronary artery disease (CAD) dihydrocodeine 463 activation during CPB 375, 377 imaging 89–93 dilated cardiomyopathy (DCM) inhibitors 116 indications for surgery 103–4 270–1 computed tomography (CT) 88–93 non-cardiac surgery 475 diltiazem 61 conducting system, cardiac 8–11 vasoregulation distal to stenosis 26 disopyramide 57, 58 effects of anesthetic agents coronary blood flow 22–3 do not resuscitate (DNAR) orders 254–5 autoregulation 23–6 416 congenital heart disease (CHD) 303, collateral 26 dobutamine 49–50, 310 313–28 pathophysiology 26–7 dopamine 49–50, 434 adult 339–43 coronary perfusion pressure 22–3 pediatric dose 310 closed cardiac surgery 306 coronary physiology 22–7 dopexamine 50 common operations 329–34 coronary sinus 6–7 Doppler ultrasound 148–50 cyanotic 306–7 coronary steal 34 double-lumen tube (DLT) 235 dysrhythmias 249 coronary vascular resistance 22, 24 down-regulation, receptor 42 outcome of surgery 338 coronary vasodilatation Down’s syndrome 318 pathophysiology 307 effects of anesthesia 33–4 dromotropy/dromotrope 30, 48 timing of surgery 305–6 flow-mediated 25 dronedarone 12 see also pediatric cardiac myocardial ischemia 26 dual-source computed tomography anesthesia coronary vasospasm 26–7 (DSCT) 90 connexons 14 Crawford classification, descending duct-dependent circulation 304, constrictive pericarditis 272–4 thoracic aortic aneurysms 232 329–30 contact activation 374–5, 377 creatinine, serum 434 ductus arteriosus (DA) 3, 313 continuous veno-venous crista terminalis 4 closure 4, 303–4 hemofiltration (CVVHF) 436 cross-clamp/fibrillation, patent (PDA) 304, 313 contractility, myocardial 19 intermittent 117 ductus venosus 3–4 effects of anesthesia 33 cyanosis 78 Duke Activity Status Index force production 14–16 congenital heart disease 306–7 (DASI) 77 perfusion and 27 Fallot’s tetralogy 320 dyspnea 76 post-bypass management cyclooxygenase II (COX-II) inhibitors dysrhythmias see arrhythmias 409–10 461, 463 regulation of force 16 cystatin C 435 early warning scores (EWS) 417 control mechanisms, cardiovascular ecarin clotting time (ECT) 67 28–32 danaparoid 66 echocardiography cooling, active 389 dantrolene 463 contrast 86 cor triatriatum 326 de-airing 110, 178, 389 stress 85, 86 CoreValve aortic valve 265 DeBakey classification, aortic transesophageal (TEE) 147–53 coronary angiography 97–100, 473–4 dissection 223–4 transthoracic (TTE) 85, 473 485

Index

edema 77 postoperative cardiac arrest G-protein-coupled receptors (GPCRs) Edwards-SAPIEN valve 264–5 415, 418 40–3 ejection fraction (EF) 155 epoprostenol 66 G-protein receptor kinases (GRKs) 43 electrocardiography (ECG) 81–5, eptacog alfa 69 gabapentin 463 472–3 eptifibatide 465–6 gap junctions 14 abnormalities 82–3 erythropoietin (EPO) 47, 372, 443 gas exchange, poor postoperative ambulatory 85 esmolol 55, 59 420–1 automated ST analysis 135, 138 esophageal Doppler (EDM) 154 gastrointestinal complications 184, exercise 81–2, 84 esophageal injuries 424–8 filters and gain 135, 137–8 iatrogenic 428 gastrointestinal hemorrhage 425–6 intraoperative 133–6, 173 traumatic 295 gastrointestinal perforation 428 lead selection 134, 136 estrogen receptor related receptors Glenn procedure 331 myocardial ischemia 133–4 (ERR) 45 glucocorticoid receptor 45–6 electroencephalography (EEG) 163–7 estrogen receptors (ER) 45 glucose management 391, 404, 443 electrolyte balance, postoperative 183 etomidate 35 glucose-insulin-potassium electromagnetic interference (EMI) EuroSCORE 105–6 solutions 116 246–7 evoked potentials 165–6, 238 glutathione S-transferase (GST) 435 electron beam computed tomography excitation–contraction coupling glyceryl trinitrate (GTN) 53–4, 310 (EBCT) 90 13–17 glycopeptide-resistant Enterococcus electrophysiological disorders 249–52 exercise electrocardiography (exECG) (GRE) 451 electrophysiological procedures 252–6 81–2, 84 glycoprotein IIb/IIIa (GPIIb/IIIa) electrophysiology, cardiac 10–12 extracorporeal membrane oxygenation antagonists 465–6 embryology 1–3 (ECMO) 363–5, 408, 423 GM1 ganglioside 443 end-diastolic pressure volume Gosling index 161 relationship (EDPVR) 20–1 factor V Leiden 467 graft rejection, acute 279 end-systolic elastance (EES) 20–1 factor VIIa, recombinant 69 Gram-negative bacilli, multi-resistant end-systolic pressure volume Fallot’s tetralogy 305, 320–1 451 relationship (ESPVR) 20–1 farnesoid X receptors 45 great arteries endo-aortic balloon clamp 217–19 fatigue 77 development 3 endocardial cushions 2 femoral cannulation 142, 216 traumatic injuries 296–7 endocarditis, infective 449–50 fenoldopam 55, 434 Gregg effect 27 native valve 197, 203 fentanyl 463 Guidant stabilization device 189 pacemaker lead-related 246 cardiovascular effects 36–7 gunshot wounds 296 prophylaxis 448–9 effects of CPB 73 prosthetic valve 129–30 pediatrics 308 halothane 33–4, 254 endothelial dysfunction 26–7 fetal circulation 3–4 heart endothelin (ET) 25–6 fibrin sealants 373 blood supply 6–7 antagonists 285 fibrinogen concentrate 372 borders 4 receptors 41 fibrinolysis 367–8, 375 conducting system 8–10 renal injury 432–3 fibromas, cardiac 290 control mechanisms 28–9 endothelium-derived hyperpolarizing flecainide 57–9 embryology 1–3 factors (EDHF) 25 flow rate, pump 176–7, 346–7, 380 nerve supply 5–6 endotoxemia 376–7 perfusion pressure and 400–1 normal anatomy 4–6 endotracheal tubes 308 fluid balance, postoperative 183, traumatic injuries 296–7 endovascular interventions 191, 433 venous drainage 6–7 aortic dissection 225 fluoxetine 463 heart block 11, 82–3, 252 intracardiac see catheter laboratory Fontan procedure 331–3 heart failure procedures surgery in adulthood 340, 342 non-cardiac surgery and 476–7 thoracic aortic aneurysms foramen ovale 2–3 pediatric patients 304–6, 308 233, 235 closure 4, 303 heart rate enflurane 33, 72 patent (PFO) 262–3 neural control 11 enoximone 51 force-frequency relationship 28–9 pediatric patients 303 enteral feeding 425, 428 fossa ovalis 4–5 post-bypass management 409 epicardium 3 fractional area change (FAC) 155, 158 heart sounds 79 epidural analgesia/anesthesia 171, 239, fractional flow reserve (FFR) 99–100 heart tube 1–2 453–5 fractional shortening (FS) 154–5 looping 1–2, 5 epidural hematoma 455–6 Frank-Starling law 18–19, 28 heat conservation 190, 383–4 epinephrine 31, 49, 50 functional status 75–6 heat exchangers 350, 389 486 pediatric patients 310, 338 fundal examination 78 heat loss, intraoperative 383–4

Index

Helex septal occluder 262–3 hypertrophic obstructive admission and handover 181 hematocrit 176–7, 357, 404–5, 441–2 cardiomyopathy (HOCM) 268–9 cardiovascular problems 409–12 hematological problems 465–8 hypokalemia 183 early postoperative care 182–5 hemodilution hypoplastic left heart syndrome postoperative circulation acute normovolemic (ANH) 372, 468 (HLHS) 327–8 management 409–10 cerebral protection 391 hypotension postoperative complications 410–12 during CPB 71, 176, 404–5 aortic valve surgery 196, 198 preparation for transfer 179, 312 hemodynamics carcinoid heart disease 214 resuscitation 413–16 invasive monitoring 141–6 during CPB 71, 176, 400–1 interatrial septum 2, 4–5 off-pump coronary surgery 189–90 mitral valve disease 202, 204 intercalated discs 14 postoperative 182, 412 postoperative 182 intercostal drains see chest drains hemofilters 353 renal injury 431–2 interleukin-18 435 hemoglobin S disease 468 hypothermia intermittent ischemia and reperfusion hemophilia 466 afterdrop 385, 390 strategy 117 hemoptysis 76 cerebral protection 391, 442–3 international normalized ratio (INR) 129 hemorrhage coagulopathy and 371 internodal tracts 9 failure to wean from CPB 356–7 failure to wean from CPB 356 interventricular septum 2–3 gastrointestinal 425–6 inadvertent 382–3 intra-aortic balloon pump (IABP) neuraxial 455–6 intraoperative 108, 113–14, 116, 357–8, 410–11 postoperative 183–4, 336–7 139, 309 intra-atrial conduction pathways 9 prosthetic valve recipients 129–30 pathophysiological effects 382–3 intravascular ultrasound (IVUS) 100–1 redo surgery 221–2 pediatric postoperative 337 intravenous anesthetic agents see also coagulopathy pharmacokinetic effects 72 cardiac conduction effects 254 hemostasis therapeutic, after cardiac arrest 385, cardiovascular effects 35 physiological 366–7 418–19 invasive diagnostic tests 95–101, post-bypass 179, 311, 363, 390 vs. normothermia 116, 402, 441 473–4 hemostatic agents, topical 373 see also deep hypothermic invasive hemodynamic monitoring hemothorax 295–6 circulatory arrest; temperature 141–6 Henry’s law 396 hypoxia, renal injury 431–3 iron supplementation 372 heparin (unfractionated heparin; ischemia-reperfusion injury (IRI) UFH) 64–5, 175, 373 ibuprofen 463 119–20, 377 allergy 468 ibutilide 57, 60 ischemic heart disease see coronary alternatives 65–6 idiopathic hypertrophic subaortic artery disease contraindications 65 stenosis (IHSS) 268–9 isoflurane 33–4, 72, 254 drug interactions 71 ileus, postoperative 424–5 isoproterenol (isoprenaline) 50 monitoring during CPB 67 iloprost 66 pediatric dose 310 off-pump coronary surgery 191 imaging, radiological 81, 87–94 isovolumic relaxation time (IVRT) 157 preoperative cessation 169 imipramine 463 resistance 64 immunosuppression 279–80 Jehovah’s Witnesses 467–8 reversal 66–7, 179 implantable cardioverter defibrillators jugular veins heparin-induced thrombocytopenia (ICDs) 241, 243–4 cannulation 142–3, 163, 171, (HIT) 64, 466 extraction 247 216–17, 309 hepatic dysfunction 427 implantation 243–4, 256 oximetry 162–4 hibernation, myocardial 119–20 surgery on patients with 244–7 pressure levels and waveforms 78 hirudin 65 inamrinone 51 junctional ectopic tachycardias 336 His system 10 induction of anesthesia 171–2 histamine 25 pediatric surgery 308–9 ketamine 463 histamine H2 receptor antagonists 425 infections 447–52 cardiovascular effects 35, 254 hormonal control 25, 31–2 cardiac transplant recipients 280 neuroprotection 443 hydralazine 55 multi-resistant bacteria 450–2 pediatrics 308 hyperbilirubinemia, postoperative 427 pediatric postoperative 338 kidney injury molecule 1 (KIM-1) 435 hypercarbia, permissive 422 inferior vena cava (IVC), renal tumor kinin–kallikrein pathway 375 hyperglycemia 391, 404 extension 388–9, 407 hyperkalemia 183, 337 inhalational agents see volatile agents labetalol 55, 60 hyperlactatemia 335, 380 inotropes 48–53, 357 labor 299 hypertension postoperative use 410 lactate, blood 335, 380 aortic valve surgery 196 inotropy see contractility, myocardial Laplace’s law 194, 410 non-cardiac surgery 475 insulin 116 left atrium (LA) 5 postoperative 182 intensive care unit (ICU) 181–5 left bundle branch block 82–3 487

Index

left heart cardiac 290 indications 104 anatomy 5 immunosuppression-related 280 percutaneous procedures 266 catheterization 95, 97–8 malnutrition, pediatric patients 338 pregnancy 300 left ventricle (LV) 5 mannitol 434 mitral valvuloplasty, balloon 203, 261 aneurysms 271–2 mapping, electrophysiological moderator band 5 pressure–volume loops 19–21 254–5 modified early warning score segments 156–7 Marfan’s syndrome 233 (MEWS) 417 left ventricular dysfunction, mean arterial pressure (MAP) 136–7, modified ultrafiltration (MUF) 311 postoperative 410–11 141, 434 monitoring, perioperative left ventricular function assessment mechanical support 357–65 artefacts 357 diastolic 157–8 mediastinal surgery 407 coagulation status 67, 175 global systolic 154–5 mediastinitis 448 invasive hemodynamic 141–6 intraoperative 154–8 medical emergency teams (MET) 417 neurological 160–7 postoperative 410 medications, preoperative cessation pediatrics 309 regional systolic 155–7 169–70 routine clinical 133–9 left ventricular outflow tract (LVOT) Medtronic Hall valve 125 transesophageal echocardiography obstruction 260, 268–9 Medtronic Octupus™ device 187, 189 147–53 leukocyte depletion 352–3, 391 membrane oxygenators 348–50, 364 ventricular function 154–9 Levine’s sign 76 mesenteric ischemia 426, 428 morphine 36–7, 463 levobupivacaine 36 metabolic acidosis 183 motor evoked potentials (MEPs) levosimendan 51 metabolic equivalents of task (METs) 166, 238 lidocaine 36, 57–8, 443 470, 472 mouth examination 78 ligands 39, 43–4 metaraminol 50 multidetector row computed biased 43–4 methylene blue 52 tomography (MDCT) 88–90, limited anterior short thoracotomy methicillin-resistant Staphylococcus 92–3 (LAST) 187, 189, 191 aureus (MRSA) 447, 450–1 murmurs, cardiac 79–80 lipomas, cardiac 290 metoprolol 57, 60 muscarinic receptors 25, 41 lipomatous hypertrophy of interatrial mexiletine 57–8 muscle relaxants see neuromuscular septum 290 milrinone 51, 310 blocking drugs lipopolysaccharide (LPS) 376–7 mineralocorticoid receptors 45 myocardial contractility liver X receptors (LXR) 45 mini-bypass circuits 353–4 see contractility, myocardial Llambl’s excrescences 290 minimally invasive cardiac surgery myocardial hibernation 119–20 local anesthetics 36 (MICS) 215–19, 373 myocardial infarction (MI), acute 257 long QT syndromes 249–50 conduct of anesthesia 215–16 complications 258–60 loop diuretics 434 conduct of surgery 216–19 non-ST-elevation (NSTEMI) 257–8 low cardiac output state (LCOS) preoperative assessment 215 perioperative 357, 410, 475 pediatrics 320–1, 335–6 minimally invasive coronary surgery ST-elevation (STEMI) 258 post-bypass 355–6 (MICS) 111 myocardial ischemia 113, 119–23 low-molecular-weight heparin minimally invasive direct coronary acute 257–60 (LMWH) 66 artery bypass (MIDCAB) 187 coronary vasodilatation 26 Lown-Ganong-Levine syndrome 249 mitochondrial permeability transition intraoperative diagnosis 133–4 lung pores (mPTP) 119–20 and reperfusion, intermittent 117 auscultation 79 MitraClip device 266 myocardial O2 delivery (MDO2) 23–4 contusions 296 mitral regurgitation (MR) 203–7 myocardial O2 demand (MVO2) 23–4 isolation, pharmacokinetic non-cardiac surgery 476 myocardial performance index effects 72 percutaneous repair 266 (MPI) 20 penetrating injuries 297 post-infarction 259–60 myocardial perfusion imaging 88–9 transplantation, CPB 407 mitral stenosis (MS) 201–3 myocardial postconditioning 121–3 see also one-lung ventilation non-cardiac surgery 476 myocardial preconditioning 119–22 lusitropy/lusitrope 30, 48 percutaneous interventions 261 myocardial protection 108–9, 113–18 lysine analogs 68–9, 175, 368–9 pregnancy 300 with cardioplegia 114–17 mitral valve (MV) 5, 200 effects of inadequate 117 magnesium sulfate 62, 443 disease 200–7 history 113–14 magnetic resonance imaging (MRI) orifice area (MVA) 200–2 redo surgery 221 cardiac disease 89, 91–3 percutaneous annuloplasty 266 myocardial revascularization surgery, pacemaker/ICD recipients 246–7 redo replacement 266 emergency 258 magnets, application of 245–6 repair 206–7, 219, 266 myocardial structure–function maintenance of anesthesia 173, 177–8 mitral valve surgery 110, 127, 200 relationships 1, 5–6 488 malignant tumors anesthetic management 202–7 myocardial stunning 27, 119–20

Index

myocardium 3 nitroglycerin (NTG) see glyceryl implantation 243–4 myocytes, cardiac see cardiac trinitrate surgery on patients with 244–7 myocytes nitrous oxide (N2O) 33, 35 pacing, temporary 178–9, 185, myofibrils 13 nitrovasodilators 53–4 247, 415 myosin 13–15 nociception 458–9 pacing spikes (potentials) 135–6, myxomas 288–9 non-cardiac surgery, and 241, 246 cardiovascular disease 469–77 pain N-acetyl-b-glucosaminidase (NAG) non-compaction cardiomyopathy chronic postoperative 462–4 435 (NCC) 274 management 458–64 Naþ/Hþ exchange inhibitors 116–17 non-invasive diagnostic tests 81–6, physiology 458–9 nail beds, examination 77 87–94, 472–3 see also analgesia near infrared spectroscopy (NIRS) non-steroidal anti-inflammatory drugs palpation 78 161–3, 310–11, 442 (NSAIDs) 461, 463 palpitations 77 neck examination 78 norepinephrine (noradrenaline) 31, 50 pancreatitis 426–7 neonates pediatric dose 310 pancuronium 35 cardiopulmonary interactions 305 renal dysfunction 434 papillary fibroelastoma 289–90 duct-dependent circulation 304, normothermia papillary muscle rupture 259–60 329–30 maintaining 383–4 paracetamol 463 normal physiology 303 vs. hypothermia 116, 402, 441 paraplegia 236, 238, 455–6 systemic and pulmonary nortriptyline 463 parasternal blockade 456 circulations 304–5 Norwood procedure 327–8 parasympathetic nervous system transitional circulation 3–4, 303–4 NovaLung iLA Membrane Ventilator® 29–31 see also pediatric cardiac 423 coronary blood flow 25 anesthesia nuclear cardiology 88–9, 93 efferents 5–6, 30 Nernst equation 10 nuclear receptors (NRs) 40, 45–7 heart rate 11 nerve supply, cardiac 5–6 nucleus of solitary tract 29–30 paravertebral blockade 456 nesiritide 56 nutrition, postoperative 428 paroxetine 463 neuraxial blockade 453–6 Parsonnet score 105 neurological complications 438–45 observation, clinical 77–8, 133 patent ductus arteriosus (PDA) conduct of CPB and 400–1, 441 octreotide 213, 426 304, 313 deep hypothermic circulatory arrest off-pump coronary artery bypass patent foramen ovale (PFO) 262–3 389–90 (OPCAB) 110–11, 117, 186–92, pediatric cardiac anesthesia glucose management and 404, 443 373, 442 307–12, 338 neuraxial blockade 455–6 anesthetic management 187–91 CPB 309–11 normothermia vs. hypothermia history 186–7 drug doses 310 402, 441 outcome and complications 191–2 induction 308–9 pediatric cardiac surgery 337 rationale 187–8 post-bypass management 311–12 neurological monitoring 160–7, 393 surgical approach 187 postoperative care 335–8 neuromuscular blocking drugs 35–6 oliguria 183, 337 premedication 308 effects of CPB 73 one-lung ventilation (OLV) 215, 219, 235 preoperative assessment 308 induction 171–2 operating room principles 303–6 neuropathic pain 460 electrophysiological interventions 255 vascular access and monitoring 309 neuroprotection see cerebral transfer to 172–3 see also congenital heart disease; protection opioids 36–7, 254, 463 neonates neuroprotective drugs 391, 397, 443–4 during CPB 73 pegorgotein 443 neurosurgery 407 induction 171–2 penetrating chest injuries 296–7 neutrophil gelatinase-associated oximetry 138–9 percussion 78 lipocalin (NGAL) 435 oxycodone 463 percutaneous coronary intervention neutrophils 377 oxygen, inspired (FiO2), neonates 305 (PCI), emergent 258 New York Heart Association (NYHA) oxygen delivery (DO2) 380 perfusion pressure, CPB 400–1 functional capacity classification oxygen free radicals 376–7 pericardial disease, imaging 91, 93 75–6 oxygenators 348–50, 364 pericardiectomy 273–4 nicardipine 54 changeout during CPB 397–8 pericarditis nimodipine 443 constrictive 272–4 nitinol 262 pacemaker cells 9–11 post-infarction 259 nitric oxide (NO) 23–5 pacemaker potential 10–11 pericardium 4 inhaled (therapy) 54, 285–6, 422–3 pacemakers, permanent (PPMs) 241–3 peroxisome proliferator-activated ischemic renal injury 432–3 classification 241–2 receptor g coactivator-1 myocardial protection 117 extraction 247 (PGC-1) 46 489

Index

peroxisome proliferator-activated propafenone 59 pulmonary vasodilators 285–6, 422–3 receptors (PPARs) 45–7 propofol 35, 254 pulmonary veins 5 persistent pulmonary hypertension of during CPB 72 pulmonary venous flow (PVF) 157–8 the newborn (PPHN) 304 neuroprotection 443 pulse 78 pexelizumab 116, 443 propranolol 57 pulse contour analysis (PCA) 154 pH-stat blood-gas management 391, prostacyclin (PGI2) 54, 66, 285, 443 pulse oximetry 138–9 403–4, 441 prostaglandin E2 304 pulse pressure variation 146 pharmacokinetic effects of CPB 71–3 prostaglandins/prostanoids 25, 285 pumps, blood 346–8 pharyngeal arch arteries 3 prosthetic heart valves 124–31 failure 398 phentolamine 54 biological 126–7 see also flow rate, pump phenylephrine 51, 310 choice 127–8 Purkinje cells 10 phosphodiesterase (PDE) inhibitors complications 128–30, 357 pediatric patients 310 hemodynamics 127 QT interval, prolonged 249–50 pulmonary hypertension 285 mechanical 124–5 quinidine 57 type III 51 non-cardiac surgery and 476 phospholamban (PLB) 15–16 protamine 66–7, 179 radial artery physical examination 77–80, 133 allergy 468 cannulation 141–2, 215 piracetam 463 protein kinase C (PKC) 40, 121 grafts 379 plasma membrane receptors 40 protein S and C deficiency 467 radiofrequency ablation plasma protein binding, during CPB 71 prothrombin complex concentrate anesthesia for 254–5 platelet function analyzers 370–1 (PCC) 69, 372 pacemaker/ICD interference 246 platelets 367–8 pulmonary artery (PA) ramus cristae terminalis 9 pneumoperitoneum 428 banding 305–6, 330–1 reactive oxygen metabolites 376–7 pneumothorax 295 catheterization 144–5, 154 receptors 39–47 polycythemia 341 traumatic injuries 296–7 blockade 43–4 positive end expiratory pressure pulmonary artery wedge pressure classification 40 (PEEP) 373, 422 (PAWP) 96, 144–5 emerging concepts 44–7 positron emission tomography (PET) postoperative optimization 409 genetic polymorphisms 43–4 88–9, 93 pulmonary atresia 322 regulation 41–3 postoperative care 181–5, 191, 219 pulmonary blood flow (PBF) red cell salvage 373, 441–2, 468 pediatrics 335–8 adult congenital heart disease 342 redo cardiac surgery 220–2 postural hypotension 77 neonatal 304–6, 329 regional anesthesia 36, 453–6 potassium (Kþ) 10–11 postoperative control 337–8 adult congenital heart disease 342 serum levels 183 pulmonary circulation pediatrics 309 potassium (Kþ) channel blockers 57, balancing, congenital heart disease regional wall motion abnormality 60–1 304–5, 342 (RWMA) 155–7 Potts shunt 330 fetal 3 relatives, communication with 182–3 prasugrel 465 perinatal changes 4, 303–4 remacemide 443 pre-excitation syndromes 249 pulmonary contusions 296 remifentanil 36–7, 73 preconditioning, cardiac, anesthetic 35 pulmonary endarterectomy 284 remote preconditioning 122 pregabalin 463 pulmonary hypertension (PHT) 282–7 renal complications 430–6 pregnancy 299–302 ARDS 422–3 cardiac transplantation 280 preload 18–19 cardiac transplantation 276–7, 279 pediatric patients 337 postoperative optimization 409 clinical features 283–4 renal impairment, pre-existing 127–8, weaning from CPB 356 congenital heart disease 282–3 435–6 premedication 170, 308 investigations 96, 284 renal replacement therapy (RRT) 430, preoperative assessment 169–70, 215, management 283–6 435–6 308 mitral stenosis 201 renal tumors, inferior vena cava preoperative autologous blood persistent, of newborn 304 388–9, 407 donation (PAD) 372 postoperative 311, 337–8, 411 renin-angiotensin system 31 pressure-controlled ventilation pulmonary regurgitation (PR) 211–12 reperfusion injury 119–20, 377 (PCV) 422 pulmonary stenosis (PS) 210–11 respiratory complications 356, 420–3 pressure gradients 149 pulmonary valve (PV) 5, 210 respiratory failure 363, 420 pressure-support ventilation disease 210–12 respiratory rate 78, 303 (PSV) 422 pulmonary vascular disease 282–7 resting membrane potential 10 pressure–volume relationships 19–21 pulmonary vascular resistance (PVR) restrictive cardiomyopathy 269–70, 273 primary survey 293, 296 276–7, 283 resuscitation procainamide 57–8 neonates 304–5 cardiac ICU 413–16 490 prone position ventilation (PPV) 422 weaning from CPB 356 catheter laboratory 418

Index

CPB for 407–8, 416 sensory evoked potentials (SEPs) subendocardial ischemia 133–4 general ward or surgical floor 165–6, 238 sufentanil 36–7, 73 416–18 septal myectomy 269 sulcus terminalis 4 late, on ICU 416 septum primum 2 superior vena cava (SVC), traumatic postoperative 413–19 septum secundum 2 injuries 296 traumatic arrest 297 serine/threonine protein kinases 40 supraventricular tachycardia (SVT) see also cardiac arrest sevoflurane 33, 254 251, 336 Reveal® implantable ECG recorder 85 shock 146 surgical site infection 448 Revised Cardiac Risk Index (RCRI), shunts, diagnostic evaluation 96 suxamethonium 35 Lee 469–70 sickle cell disease 468 sympathetic nervous system 29–31 rewarming 139, 178, 384–5 signal transduction cascade 39–40, 42 coronary blood flow 25 deep hypothermic circulatory signs of cardiac disease 77–80 efferents 5–6, 30 arrest 390 single photon emission computed heart rate 11 pediatric patients 309–10 tomography (SPECT) 88–9, symptoms of cardiac disease 75–7 rhabdomyomas 290 91, 93 syncope 76–7, 194 rheumatic heart disease 201, 203, sinoatrial (SA) node 9 exertional 77 206, 208 action potential 10, 11 systemic arterial to pulmonary rhythm, post-bypass management 409 neural control 11 shunts 305 rib fractures 294 sinus venosus 1, 2 systemic circulation, balancing RIFLE classification 431–2 skin, examination 77, 78 304–5, 342 right atrial pressure (RAP) 142, 144, 146 Society of Thoracic Surgeons (STS) systemic inflammatory response right atrium (RA) 4 risk model 105 syndrome (SIRS) 338, 374–80, cannulation, for CPB 109, 176 sodium (Naþ) 10–11 432 right bundle branch block 82–3 sodium nitroprusside 53–4, 310 definition 374 right heart somatic pain 459 pathophysiology 374–8 anatomy 4–5 sotalol 57, 59–60 therapeutic intervention 378–80 catheterization 95–6, 98 spinal anesthesia 454–5 systemic vascular resistance (SVR) right-to-left shunts 305 spinal cord 144, 146 right ventricle (RV) 4–5 arterial supply 236–7 estimation during CPB 356 pressure–volume loop 20 injury/ischemia 236 neonates 305 right ventricular (RV) dysfunction/ protection 236–8, 393 weaning from CPB 356 failure spinal cord stimulation 463–4 systemic venous to arterial shunts 306 Fallot’s tetralogy 320–1 ST-segment analysis, automated systolic anterior motion (SAM) of postoperative 311–12, 411 135, 138 anterior mitral leaflet 206–7, pulmonary hypertension 283, 286 stab wounds 296 260, 268 valvular disease 208, 210, 212 staircase effect 28–9 systolic function right ventricular (RV) function Stanford classification, aortic determinants 18–19 assessment 158–9 dissection 223 regulation 16 ventricular assist device 363 Starr–Edwards valve 124 risk assessment stellate ganglion 6, 11 T tubules 13 cardiac, non-cardiac surgery sternal closure, delayed 311 tachycardia, postoperative 182, 336 469–72 sternal fractures 295 tachydysrhythmias 250–2 cardiac surgery 104–5, 106 sternotomy 109, 187, 191 tamponade, pericardial robotically-assisted surgery 111 chronic pain 462 postoperative 336–7, 411–12 rofecoxib 463 emergency re-opening 416–18 traumatic 297 roller pumps 346–7 repeat 220–1 temperature Ross procedure 127, 333–4 Stewart-Hamilton equation 144, 146 control 382–6, 388 Stokes-Adams attacks 77 core 382 saphenous neuralgia 462 stress echocardiography 85–6 maintenance measures 383–4 saphenous vein conduits 379 stress imaging, cardiac 88, 473 monitoring 139, 309, 382, 388 2þ sarco-endoplasmic reticulum Ca - stroke see also hypothermia ATPase (SERCA) 15–16 perioperative 400–1, 438–45, 477 tetralogy of Fallot 305, 320–1 sarcolemma 13 previous history 440, 477 Thebesian veins 6 sarcomas, cardiac 290 see also neurological thermodilution method 144, 146 sarcomere 13–14 complications thermoregulation 382–3 scars, surgical 77 stroke volume (SV) 20 thiopental 35, 254 scintigraphy 88–9, 93 estimation 149–50, 155 neuroprotection 391, 443 second messengers 40 stroke work 20 thoracic surgery, non-cardiac 406–7 sedation, postoperative 182 subclavian vein cannulation 142, 171 thoracic trauma 293–8 491

Index

thoracotomy tricuspid regurgitation (TR) 209–10 venous reservoir, CPB 350–1 chest trauma 295, 297 tricuspid stenosis (TS) 208–9 ventilation, mechanical 182 limited anterior short (LAST) 187, tricuspid valve (TV) 4, 208 ARDS 421–2 189, 191 disease 208–10 ECMO 364 thrombin inhibitors, direct 65, 67 surgery 209–10 failure to restart, post-bypass 356 thrombocytopenia 466 troponin–tropomyosin complex pediatric patients 305, 337–8 thromboelastography (TEG) 370 14–16 postoperative resuscitation 416 thromboembolism, after valve truncus arteriosus (TA) 1, 3, 325 ventricular aneurysms 271–2 replacement 128–9 tuberculosis 272 ventricular assist devices (VADs) thrombophilia 467 tubing, CPB 351–2 359–63, 411 thrombotic tendency, increased 466–8 tumors, cardiac 288–92 ventricular dysfunction thrombus, intracardiac 291–2 postoperative 410–11 thyroid hormone receptor 45 ultrasound weaning from CPB 355 tirofiban 465–6 epiaortic 441 ventricular extrasystoles 251–2 tissue Doppler imaging (TDI) 155, 158 intravascular (IVUS) 100–1 ventricular fibrillation (VF) 252, 256 tissue plasminogen activator (t-PA) physics 147–50 catheter laboratory 418 368, 375 umbilical vessels 3–4 postoperative 414–16 titin 14 univentricular heart 306, 329–33 ventricular free wall rupture torsade des pointes 252 unstable angina (UA) 257–8 259, 271 total anomalous pulmonary venous urinary catheterization 185 ventricular function, intraoperative drainage (TAPVD) 305, 326 urine output 434 assessment 154–9 total cavopulmonary connection urokinase plasminogen activator ventricular performance 18–21 (TCPC) see Fontan procedure (u-PA) 368, 375 ventricular septal defects (VSD) 317 tracheal extubation urological surgery 407 percutaneous closure 263–4 criteria 182 ventricular septal rupture 259 failed 184–5 VACTERL syndrome 317 ventricular tachycardia (VT) 252 tracheobronchial injuries 295 vagus nerve 5–6, 11 catheter laboratory 418 tracheostomy 423 valproate, sodium 463 postoperative 414–16 tramadol 463 valvular heart disease ventriculo-arterial coupling 21 tranexamic acid (TXA) 68–9, 175, 368 imaging 91–3 ventriculography 97, 100 transcatheter aortic valve implantation non-cardiac surgery 475–6 verapamil 57, 61 (TAVI) 264–6 prosthetic valves 124–31 vernakalant 12 transcranial Doppler (TCD) 161–2 vancomycin 450–1 visceral pain 459 transesophageal echocardiography vancomycin-resistant Enterococcus vitamin D receptor 45 (TEE) 147–53 (VRE) 451 volatile agents indications 152 vasoconstrictors 49–53 CABG 173 ventricular function 154–9 vasodilators 53–6, 385 cardioprotection 122–3 transitional circulation 3–4, 303–4 vasopressin 52, 415, 426 cardiovascular effects 33–5, 254 transmitral flow (TMF) 157–8 pediatric dose 310 effects of CPB 72 transmural ischemia 133–4 vasopressors, cardiac arrest 415 pediatrics 308 transposition of great arteries (TGA) Vaughan Williams classification 57–61 volume regulation 29–30 305, 323–4 vecuronium 35 volume status, dynamic markers transpulmonary gradient (TPG) vegetations 292 144–6 276–7 veins, traumatic injuries 296 von Willebrand’s disease 466 transthoracic echocardiography (TTE) velocity time integral 149–50 85, 473 venous cannulae 351 warfarin 129–30 trauma, cardiothoracic 293–8 venous cannulation reversal 372 TRAVVEL mnemonic 179 aortic surgery 234 Waterstone shunt 330 treppe effect 28–9 CPB 109, 176, 216 Wolff-Parkinson-White (WPW) triiodothyronine (T3) 52 ECMO 364 syndrome 249–50, 255 tricuspid annular plane systolic pediatric patients 309 women of childbearing age, valve excursion (TAPSE) 158 venous drainage, heart 6 replacement surgery 128

492