Simulation in coronary artery anastomosis early in cardiothoracic surgical residency training: The Boot Camp experience

We evaluated focused training in coronary artery anastomosis with a porcine heart model and portable task station

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Cardiopulmonary Bypass on a 1.0 Kilogram Infant for Removal of a Trans-Atrial Mycetoma

A premature, 1.0 kilogram infant developed an umbilical venous catheter thrombus which extended through the patent foramen ovale and into the left side of the heart. After consultation with the physicians, the perfusion team was asked to adapt the bypass pump as needed to perfuse the tiny baby. The preparation also included evaluation of a 14 and 16 gauge angiocatheter to be used in the event that the standard 8 Fr. cannula was not sufficient. The mycetoma was excised during circulation arrest. The hematocrit of 20% during bypass was increased to 29% during rewarming of the patient via hemoconcentration. The patient was hemodynamically stable postoperatively and was transferred back to the referring hospital several days later. The patient died six weeks later of sepsis

Optimizing Venous Drainage Using an Ultrasonic Flow Probe on the Venous Line

The use of smaller cannulae for minimally invasive surgery techniques and/or aggressive miniaturization of the cardiopulmonary bypass (CPB) circuitry has necessitated the need to augment venous drainage to achieve adequate flow rates. Vacuum assisted venous drainage (VAVD) has become the dominant method to augment venous drainage. VAVD, however, has been associated with a number of known side effects including increased transmission of gaseous microemboli to the patient, venous line chatter, and increased arterial to venous shunts in the circuit. Historically, our practice has been to monitor the arterial output flow rate and to monitor VAVD by observing venous line chatter and changes in the venous reservoir level. In 2008 our pediatric cardiothoracic service began monitoring venous line flow rates by using a second ultrasonic flow probe placed on the venous line. After 12 months, our staff perfusionists reviewed the impact of monitoring venous line flow rates on VAVD and its known side effects on daily clinical practice. When monitoring venous line flow rates, empiric observation revealed that less overall vacuum pressure was needed for our CPB cases. This novel approach to monitoring venous drainage has aided us in providing optimal vacuum levels and therefore, may reduce some of the known side effects experienced with excessive VAVD

Postoperative internal thoracic artery spasm after coronary artery bypass grafting

Spasm of the left internal thoracic artery in the perioperative period represents a life-threatening complication after coronary artery bypass grafting. We present a case in which graft spasm was treated with the administration of intra-arterial nitroglycerin and verapamil. Although vasospasm is more often seen in radial artery grafts, this case demonstrates that left internal thoracic artery grafts are also prone to spas