April 25, 2017
We’re getting right back into the groove of things after the Society of Cardiovascular Anesthesiologists Annual Meeting. Duke had a very strong representation at the scientific sessions, fellow sessions, and workshops, and it was great to see everyone there. Take a look at the pictures below.
With Duke Anesthesiology’s Academic Evening coming up, I want to highlight the many opportunities available to showcase your research in addition to national conferences (like Jack and Alina did at the SCA!). Dr. Aman Mahajan, a chairman at UCLA, will be our guest judge for the 25th Annual Academic Evening on May 16th at the Millennium Hotel. Two days later on May 18th, the Duke University School of Medicine is hosting the annual Clinical Research Day with five guest presentations by Drs. Robert Califf, Geraldine Dawson, Allan Kirk, Nandan Lad, and Ann Marie Navar. Last year, our very own, Dr. Sarah Cotter, won first place in the poster competition with her abstract on blood-brain barrier permeability and cognitive dysfunction after cardiac and non-cardiac surgery.
The ACGME also announced a grassroots, trainee-driven initiative for finding meaning in the work you do every day. This Back to Bedside initiative will provide funding, national dissemination of successful projects, and the creation of learning collaboratives made up of trainee-led research teams. Focus areas included creating opportunities for more time engaged in direct, meaningful patient care, developing a sense of teamwork and respect among colleagues, decrease effort on non-clinical administrative responsibilities, etc. You have all of the tools to develop a project that could directly affect the ACGME common program requirements (the document that rules all programs)!
Attendings and CRNAs, thank you for getting the residents out earlier than usual for my meeting with them last Thursday. For those who couldn’t join, we spoke about studying tips and lecture attendance requirement of 80 percent.
Don’t forget to sign up for our Transition to Practice Retreat, hosted jointly by UNC. It is a great way to network with your colleagues at other institutions, and for those who participate (pay attention here) you will receive lecture credit for every hour you attend. So come for the camaraderie, fun, and fulfillment of ACGME requirements. The program is being finalized, but here are some of the topics: operating room management, evaluation of areas of practice, contract negotiations, billing and coding, professionalism, leadership, professional liability, and fiscal responsibility to yourself, patients, and the larger health system.
For CA-1s preparing for the BASIC exam, I know misery loves company, so check your email about an upcoming event.
Our DARE blog series will continue next week with our own Dr. Brian Rogers remarking on his global health mission in Ghana.
Congratulations to Lauren and Davis on their beautiful addition to our anesthesia family! Don’t forget to RSVP to Shelby for the Durham Bulls game (Saturday, June 3rd) and graduation (Saturday, June 17th)!
Have a great week!
Presented at SCA 2017
Congenital Quadricuspid Aortic Valve in patients undergoing AVR for Aortic Insufficiency
Alina Hulsey, MD, Cory Maxwell, MD, and Ryan Konoske, MD
Introduction: Aortic insufficiency (AI) is a common cause of patients undergoing aortic valve replacement (AVR). Frequently, it is the result of degenerative (calcific) processes of the aortic valve that typically result in mixed stenosis and insufficiency. Congenital valvular abnormalities are less common with congenital bicuspid aortic valve occurring in 2% of patients. Even rarer is that of quadricuspid aortic valve (QAV), a congenital valvulopathy resulting in 4 cusps of the aortic valve. The mean age of presentation is between 46 and 50 years, with a slight male predominance (1.6:1). We present two patients at the Durham VAMC undergoing AVR for severe AI due to a QAV.
- Quadricuspid aortic valve is an uncommon congenital aortic valve abnormality with a reported incidence between 0.008%- 0.043%.
- AI was the most common pathology associated with QAV (75% of cases)
- QAV is associated with other congenital anomalies including coronary artery abnormalities (10% of cases), VSD, PDA, pulmonary stenosis, hypertrophic cardiomyopathy, and complete heart block.
- These associations necessitate a complete intraoperative TEE examination to exclude pathology warranting surgical intervention.
- Data from a case series of 200 patients indicates that the diagnosis of QAV was made at the time of surgery in 22.6% of cases as was the case for patient 1.
- The incidence of QAV is quite low, however this is likely underreported.
- Important to be aware of potentially anomalous origin of the left coronary ostia, which can be damaged during AVR.
- Majority of patients have significant worsening AI requiring AVR, in the 5th or 6th decade of life.
- It is not uncommon to have subacute bacterial endocarditis associated with QAV, and, although there is a reported low incidence (2%), one should consider antibiotic prophylaxis
- The diagnosis of QAV is typically accomplished by echo, while surgical decision making is based on the severity of aortic regurgitation and any associated congenital lesions, underscoring the importance of thorough echocardiographic evaluation.
- Tutarel O. The quadricuspid aortic valve. J. Heart Valve Dis.2004;14:534–7
- Malviya A et all. Quadricuspid aortic valve – A case report and literature review, The Egypt Heart J (2015), http://dx.doi.org/10.1016/j.ehj.2015.09.003
- Hurwitz LE, Roberts WC. Quadricuspid semilunar valve. Am J Cardiol 1973;31:623–626
This weekend (4/29-30): Overmon, Anderson
Next weekend (5/6-7): Bluth, Castro
This week (Sat PM 4/29 – Fri AM 5/5): Reskallah, Devinney
Next week (Sat PM 5/6 – Fri AM 5/12): Herbert, Fox
Friday Night Call
This Friday (4/28): Thapa, Donald
Next Friday (5/5): S. Jones, Andrews
Liver Call Weekend (pager: 7320)
This weekend (Fri PM 4/28 – Sun PM 4/30): McCauley
Next weekend (Fri PM 5/5 – Sun PM 5/7): Wang
Liver Call Weekday (pager: 7320)
Liver day (Mon AM 5/1-Fri PM 5/5): Brockbank
Liver night (Sun PM 4/30 – Fri AM 5/5): Overmon
Saturday 4/29 AM: Bluth
Saturday 4/29 PM: Pleticha
Sunday 4/30 AM: Seifert
Saturday 5/6 AM: Brockbank
Saturday 5/6 PM: Pleticha
Sunday 5/7 AM: K. Smith
This Friday (4/28): Bangura, Anderson
Next Friday (5/5): Castro, Mangubat
Simulator (4-6 p.m. — page charge CRNA *7853 to ask for relief at 3:45 p.m.)
*These are mandatory sessions*
Mon (5/1): Horazeck, Johnbull, Mangan
CA3 on call pager (970-9313) is covered by CA3 on general OR call.
Liver call pager (970-7320) is always covered.
Have a good week!
Please stop by during the office hours listed below. Or, please feel free to contact any of our leadership to schedule a meeting outside of standard office hours.
Dr. Annemarie Thompson (Program Director): Check your email as AMT noted above.
Our APDs will be alternating months for official office hours.
Dr. Ankeet Udani (Program Assistant Director): Dr Udani is currently out of the country teaching others how to be better teachers so his office hours for May will be updated once the he sees the email from the time difference!
Don’t forget to register for the Transition to Practice joint conference with UNC!
Duke Health wants to showcase our residents online! Please contact Jennifer Schwabel and Jessica Burkhart if you’re interested in creating a video for your physician profile page! Check out Dr. Thomas Buchheit’s profile video for a great example.
Want to talk with someone?
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This Week in Lectures
CA1 (4/25): Physiology of Brain Ischemia with Dr Dave Warner
CA2/3 (4/26): Airway Ultrasound with Dr Bret Stolp
Thursday (4/27): Basics of Hemodynamics Assessment with Dr Yasmin Maisonave
Next Week in Lectures
CA1 (5/2): From Lumbar Drains to Exploding Brains to the Site of Memory’s Domain: A Brief Tour of Neuroanesthesiology with Dr Miles Berger
CA2/3 (5/3): Geriatric Clinical Pharmacology with Dr Dana Wiener
Thursday (5/4): Pericardial Effusions and Cardiac Masses with Dr Rebecca Klinger
Private practice group in Lewes Beach Delaware is expanding! See Dr Jay Hutson’s email in the jobs box account for more details about the job and how to reach him.
Emory is expanding faculty – high risk OB, peds, cards, thoracic, general cases, etc. Contact Dr Bola Faloye, 2013 alumni, for more information. Contact information is in box account!