The role of peri-operative transoesophageal echocardiography

Cardiac surgery and anaesthesia have come a long way since the late 1970s when Transoesophageal Echocardiography (TOE) was introduced into the peri-operative arena. The development of many surgical procedures and the reduction in peri-operative morbidity and mortality can be directly related to the use of TOE. In complicated surgery it has the benefit of providing real time interrogation of cardiac structures and function that can be reliable and repeatable. As with many interventions a full understanding of the limitations, possible artefacts and operating environment is required to benefit patient care. In 1996 an American Society of Anaesthesiologists/Society of Cardiovascular Anaesthesiologists Task Force published guidelines on the indications for intra-operative TOE. These published guidelines have been updated in 2003 and have recently been reviewed once again in the USA and Europe. In this document we discuss the role of peri-operative TOE and its use and value during some Category I procedures

Quadruple valve replacement in a patient with severe rheumatic heart disease

We present a patient with rheumatic heart disease involving all the heart valves. An intraoperative transoesophageal echocardiography confirmed severe mitral stenosis, severe aortic regurgitation, severe tricuspid regurgitation and stenosis, and severe pulmonary stenosis. The patient underwent successful quadruple valve replacement during a single operation at the Groote Schuur Hospital, Cape Town, South Africa

Gas exchange indices how valid are they?

No Abstract

How I do it: transapical cannulation for acute type-A aortic dissection

Aortic dissection is the most frequently diagnosed lethal disease of the aorta. Half of all patients with acute type-A aortic dissection die within 48 hours of presentation. There is still debate as to the optimal site of arterial cannulation for establishing cardiopulmonary bypass in patients with type-A aortic dissection

A meta-analysis of the efficacy of preoperative surgical safety checklists to improve perioperative outcomes

Background. Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.Objective. To determine the efficacy of the SSC using data from randomised controlled trials (RCTs).Methods. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.Results. Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital, with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection, attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59, 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64, 95% CI 0.57 - 0.71; p<0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59, 95% CI 0.21 - 1.70; p=0.33, cardiac complications RR 0.74, 95% CI 0.28 - 1.95; p=0.54, infectious complications RR 0.61, 95% CI 0.29 - 1.27; p=0.18, and perioperative bleeding RR 0.36, 95% CI 0.23 - 0.56; p<0.00001.Conclusions. There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However, randomised evidence of the efficacy of the SSC at rural hospital level is absent

Use of TOE in congenital cardiac surgery

Recording of presentation given by Justiaan Swanevelder with the title 'Use of TOE in congenital cardiac surgery', presented on Wednesday, 13 March 2019 as part of the Inaugural PROTEA (Partnerships for Children with Heart Disease in Africa) Workshop in Cape Town, South Africa.The 13th-16th March 2019 marked the Inaugural PROTEA (Partnerships for Children with Heart Disease in Africa) Workshop hosted by the Children’s Heart Disease Research Unit under the directorship of A/Prof Liesl Zuhlke and in conjunction with the Paediatric Cardiology Service of the Western Cape. A first in Africa, this workshop combined four events: a research methods workshop, a basic echocardiography (echo) workshop, two days of advanced echo as well as a rheumatic heart disease research think-tank. 130 delegates from 19 different countries representing all six continents attended the event, making it truly global and giving attendees the opportunity to meet and network with experts in the fields of rheumatic and congenital heart disease.</div

Extracorporeal membrane oxygenation ECMO in South Africa

Extracorporeal membrane oxygenation (ECMO) is an advanced modality of life support for neonatal, paediatric and adult patients with cardiopulmonary compromise resistant to conventional critical care management. This issue of SAJCC features a position statement proposing guidelines for the use of ECMO in South Africa, where unique clinical scenarios are often presented for critical care management. ECMO should be available for selected cases in advanced healthcare systems, and it should be performed in centres that have done the necessary planning, preparation and training

Quadruple valve replacement in a patient with severe rheumatic heart disease

We present a patient with rheumatic heart disease involving all the heart valves. An intraoperative transoesophageal echocardiography confirmed severe mitral stenosis, severe aortic regurgitation, severe tricuspid regurgitation and stenosis, and severe pulmonary stenosis. The patient underwent successful quadruple valve replacement during a single operation at the Groote Schuur Hospital, Cape Town, South Africa

Extracorporeal Circulatory/Life Support: An Update

The evolution of extracorporeal life support technology has added a new advanced dimension to intensive care management of acute cardiac and/or respiratory failure in neonatal, pediatric, and adult patients who fail conventional treatment. ECMO has been a controversial subject within the intensive care community for many years. Perceptions have, however, changed positively over the past decade due to a need for improved management of these groups of patients, technological advances, and evolving evidence. As is common with many emerging therapies, its optimal use is currently not fully backed by quality evidence