Edition - Kaplan 39-s Cardiac Anesthesia 8th

Maya glanced at the open page: Chapter 14: Valvular Heart Disease – Management of Acute Aortic Regurgitation. Eleanor had a bicuspid valve, calcified and incompetent. The repair was done, but the cross-clamp had just been released. Now, the newly reconstructed valve was leaking torrentially.

“That’s not a repair issue,” murmured Dr. Aris Thorne, the senior attending. His voice was dry ice. “That’s a ventricular issue. Look at the TEE.” kaplan 39-s cardiac anesthesia 8th edition

That night, she sat on her apartment floor surrounded by empty coffee cups. She opened the book not to study, but to write. In the margin next to the nitroprusside dosing chart, she scribbled: “Used in OR 7, 10/14. Eleanor Vance, 74. Worked like a dream.” Maya glanced at the open page: Chapter 14:

Rick scoffed. “Pull the balloon? She’s barely perfusing.” Now, the newly reconstructed valve was leaking torrentially

Dr. Thorne was silent for three heartbeats. Then: “Rick, deactivate and withdraw the IABP. Pharmacy, 0.5 mcg/kg/min nitroprusside. Maya, set the pacer to 120 bpm.”

The transesophageal echocardiography screen showed a left ventricle dilating like a water balloon. The pressure curve on the monitor looked like a dying pulse. The textbook’s words echoed in Maya’s memory: “Acute, severe aortic regurgitation after clamp release is a medical emergency. Phenylephrine is contraindicated. Inotropes worsen the regurgitant fraction. The answer is afterload reduction and rapid pacing.”

“Page 847,” he said. “The paragraph on vasodilator therapy in acute post-pump AR. I underlined it eight years ago during my fellowship. I never thought anyone would actually read it.”