Dataset Information

Problem-Based Learning Discussion on Neuraxial Anesthesia in Parturients With Repaired Tetralogy of Fallot.

ABSTRACT:

Introduction

Approximately 1% of all children born in the United States suffer from congenital heart disease, and 25% of those affected are born with critical congenital heart disease requiring surgical intervention. Advances in cardiac surgery have allowed an increasing number of patients with complex congenital heart disease to live into adulthood. It is important that anesthesiologists understand the particularities of providing safe clinical care for these patients in different situations.

Methods

This problem-based learning discussion (PBLD) was created to expose medical students, anesthesiology residents, and anesthesiology faculty members to potential clinical situations involving the management of an adult parturient with a repaired tetralogy of Fallot defect who is in labor. The discussion focuses on reviewing and reinforcing an understanding of the clinical implications of the defect before and after repair, as well as the specific anesthetic considerations with regard to these patients.

Results

This PBLD has been delivered on two separate occasions to a number of faculty members (N = 10), resident physicians (N = 12), a medical student (N = 1), and nurse anesthetists (N = 2) within our institution. It has been very well received and has stimulated discussion surrounding care for an adult parturient with a complex cardiac history within our facility. The exercise was evaluated anonymously by all participants and has been very positively reviewed.

Discussion

We are confident that this PBLD, after significant efforts, has become a substantial and informative learning tool for medical students, anesthesiology residents, nurse anesthetists, and faculty alike.

SUBMITTER: Aird D

PROVIDER: S-EPMC6440416 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Publications

Problem-Based Learning Discussion on Neuraxial Anesthesia in Parturients With Repaired Tetralogy of Fallot.

Aird Desiree D Ellis Terry T Krishnan Sandeep S

MedEdPORTAL : the journal of teaching and learning resources 20161103

<h4>Introduction</h4>Approximately 1% of all children born in the United States suffer from congenital heart disease, and 25% of those affected are born with critical congenital heart disease requiring surgical intervention. Advances in cardiac surgery have allowed an increasing number of patients with complex congenital heart disease to live into adulthood. It is important that anesthesiologists understand the particularities of providing safe clinical care for these patients in different situa ...[more]

PMID: 30984833

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Project description:Background and purposeElectromechanical dyssynchrony, manifested by right bundle branch block and regional wall mechanical dysfunction, contributes to inefficient RV function in repaired Tetralogy of Fallot (ToF). This study aims to evaluate the synchronicity of multiple RV walls using two-dimensional multi-plane echocardiography (2D-MPE) in order to augment current understanding of the mechanisms behind RV dyssynchrony.MethodsSixty-nine adult ToF patients [aged 33 (23-45) years; 61% male] and twenty-five matched healthy controls underwent deformational analysis of the RV lateral, anterior, inferior and septal walls following 2D-MPE acquisitions. RV synchronicity was assessed by the intra-RV deformation delay between each basal RV wall and mid-septal segment in addition to mechanical dispersion calculated across four, six and eight segments (MD).ResultsAll RV wall-septum delays plus MD-4 and MD-6 indices were significantly greater in ToF patients compared to healthy controls (p < 0.001-0.03). In ToF patients, the lateral and anterior RV walls were last to reach peak deformation and anterior wall longitudinal strain was lower (p = 0.001). Post systolic shortening of at least one RV wall segment was identified in 19 (28%) ToF patients. Despite similar ECG characteristics, lateral and anterior wall-septum delays were significantly longer in patients with greater degrees of dyssynchrony (73 [37-108]ms vs. 37 [0-63]ms, p = 0.006; 91 [52-116]ms vs. 41 [1-69]ms, p = 0.013), although RV ejection fraction (RVEF) was not significantly lower. MD-4 and MD-8 indices displayed moderate negative associations with RVEF, strengthened by inclusion of lateral wall longitudinal strain (r = 0.64/0.65; p ≤0.01).ConclusionRV dyssynchrony in ToF is characterised by electromechanical delays between the lateral, anterior and septal walls, with anterior wall dysfunction likely associated with surgical repair of the RV outflow tract. Prospectively, 2D-MPE may have an emerging role evaluating RV mechanical response to electrical resynchronisation therapy.

Project description:BackgroundIn repaired tetralogy of Fallot (rTOF), abnormal left ventricular (LV) rotational mechanics are associated with adverse clinical outcomes. We performed a comprehensive analysis of LV rotational mechanics in rTOF patients using cardiac magnetic resonance (CMR) prior to and following surgical pulmonary valve replacement (PVR).MethodsIn this single center retrospective study, we identified rTOF patients who (1) had both a CMR ≤ 1 year before PVR and ≤ 5 years after PVR, (2) had no other intervening procedure between CMRs, (3) had a body surface area > 1.0 m2 at CMR, and (4) had images suitable for feature tracking analysis. These subjects were matched to healthy age- and sex-matched control subjects. CMR feature tracking analysis was performed on a ventricular short-axis stack of balanced steady-state free precession images. Measurements included LV basal and apical rotation, twist, torsion, peak systolic rates of rotation and torsion, and timing of events. Associations with LV torsion were assessed.ResultsA total of 60 rTOF patients (23.6 ± 7.9 years, 52% male) and 30 healthy control subjects (20.8 ± 3.1 years, 50% male) were included. Compared with healthy controls, rTOF patients had lower apical and basal rotation, twist, torsion, and systolic rotation rates, and these parameters peaked earlier in systole. The only parameters that were correlated with LV torsion were right ventricular (RV) end-systolic volume (r = - 0.28, p = 0.029) and RV ejection fraction (r = 0.26, p = 0.044). At a median of 1.0 year (IQR 0.5-1.7) following PVR, there was no significant change in LV rotational parameters versus pre-PVR despite reductions in RV volumes, RV mass, pulmonary regurgitation, and RV outflow tract obstruction.ConclusionIn this comprehensive study of CMR-derived LV rotational mechanics in rTOF patients, rotation, twist, and torsion were diminished compared to controls and did not improve at a median of 1 year after PVR despite favorable RV remodeling.

Dataset Information

Problem-Based Learning Discussion on Neuraxial Anesthesia in Parturients With Repaired Tetralogy of Fallot.

Introduction

Methods

Results

Discussion

Publications

Problem-Based Learning Discussion on Neuraxial Anesthesia in Parturients With Repaired Tetralogy of Fallot.

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