May 16, 2017
The residency newsletter now has an official title and an official winner! “Vital Signs,” measurements of the body’s most essential functions, is a perfect analogy to describe the newsletter and our readers who provide vital care every day. “Vital Signs” has and will continue to provide updates and highlights on the program. Jason Hall, a current CA-1, submitted the winning name and has chosen a lunchbox as his prize. I thought he might go for the Duke tie or the Duke polo shirt, but the Duke lunchbox won out. Congratulations, Jason!
Thank you to all who came out to the “Transition to Practice Seminar,” a collaboration with our neighbors at UNC. In addition to checking off ACGME requirements, the lectures were informational and entertaining. Thank you to Dr. Brian Colin for working with Dr. Kim Nichols on making the seminar happen. Thank you to our DRH colleague, Dr. Chris Gratian, for participating in the panel discussion as well.
This week, I’m looking forward to spending time with Dr. Aman Mahajan, chair of anesthesiology at UCLA, who is joining us for the 25th Annual Duke Anesthesiology Academic Evening tonight. I hope you all can attend and see the amazing work our residents, fellows and faculty are doing.
It looks like a lot of people have RSVP’d for the Durham Bulls game (June 3rd at 6pm) and graduation (June 17th)! It is not too late for faculty and residents to sign up for these events. Please email Shelby and let her know you’d like to attend.
Orientation for our soon to be CA-1s is less than one month away! We are excited to welcome the interns to the beginning of their formal anesthesiology training.
Congratulations to Rachael and Eric on their beautiful addition to our anesthesia family!
And a shout out to Dr. Eric JohnBull, who received a gold star from one of his patients in the CTICU. Thank you for the outstanding care you provide our patients!
Have a great week!
Presented at SCA 2017
Minimally Invasive Repair of a Double Orifice Mitral Valve
John F. Gamble, MD, Eun J. Eoh, MD, Donald Glower, MD, Nicole R. Guinn, MD
Introduction: Congenital anomalies of the mitral valve are rare and can be associated with variable changes in valvular function. Double orifice mitral valve (DOMV) is a congenital anomaly in which the mitral valve is composed of a single fibrous annulus with two orifices opening into the left ventricle, often associated with an abnormality of the papillary muscles and/or chordae tendineae1. The clinical presentation varies, depending on the degree of associated stenosis or regurgitation, as well as the presence of additional cardiac anomalies2. We present a case of a patient with nonrheumatic mitral insufficiency undergoing elective mitral valvuloplasty via Heartport, found to have a complete bridge type DOMV.
Case Presentation: A 63-year-old male with history of hiatal hernia and esophageal Schatzski ring was found to have severe mitral regurgitation during evaluation of dyspnea on exertion and scheduled for mitral valve repair. Preoperative transthoracic echocardiography (TTE) showed mildly decreased left ventricular function and mitral valve with bileaflet prolapse and severe regurgitation.
Given the patient’s history of a symptomatic Schatzski ring, we placed a pediatric transesophageal probe. Initial images revealed the presence of moderate mitral regurgitation with two individual eccentric jets. Surgical exposure via thoracotomy revealed a congenital DOMV with presence of a complete fibrous bridge (Figure 1). The surgeon elected to preserve the fibrous band and mitral valvuloplasty was performed with a 34mm Simulus Ring. Postprocedure echocardiographic images demonstrated trivial regurgitation of the repaired valve. Postoperative recovery was uneventful and the patient was discharged to home on POD 4.
Discussion: DOMV is a rare congenital cardiac anomaly resulting in two orifices opening into the left ventricle. Clinical presentation of DOMV varies and depends on the presence of concomitant cardiac anomalies, as well as degree of mitral valve dysfunction, with valvular insufficiency more common than stenosis2.
Diagnosis of DOMV may be accomplished via 2D TTE. Our preoperative TTE noted eccentric anterior and posterior directed jets, and intraoperative TEE demonstrated two anterograde flows through the mitral valve, which are pathognomonic for DOMV. Unfortunately, our ability to characterize the morphology of the valve via intraoperative TEE was limited by the use of a pediatric transesophageal probe; therefore, it was through direct visualization that the isolated, complete fibrous bridge was identified. In conclusion, we report a rare case of complete bridge type DOMV without concomitant anomalies that underwent a successful minimally invasive repair.
CENTRAL LINE :: 5/14 – 5/20
This weekend: (5/13) Reskallah, Devinney, (5/14) Reskallah, Cobert
Next weekend: (5/20-21): Seifert, Donald
This week (Sat PM 5/13 – Fri AM 5/19): Hulsey, Chen
Next week (Sat PM 5/20 – Fri AM 5/26): Overmon, Castro
Friday Night Call
This Friday (5/12): Seifert, Cobert
Next Friday (5/19): Thapa, Fox
Liver Call Weekend (pager: 7320)
This weekend (Fri PM 5/12 – Sun PM 5/14): Doshi
Next weekend (Fri PM 5/19 – Sun PM 5/21): Mangan
Liver Call Weekday (pager: 7320)
Liver day (Mon AM 5/15-Fri PM 5/19): Crowgey
Liver night (Sun PM 5/14 – Fri AM 5/19): Reskallah
Saturday 5/13 AM: Jia
Saturday 5/13 PM: Pleticha
Sunday 5/14 AM: Seifert
Saturday 5/20 AM: Anderson
Saturday 5/20 PM: Pleticha
Sunday 5/21 AM: Thapa
This Friday (5/12): Chen, Mangubat
Next Friday (5/19): Donald, Mangubat
Simulator (4-6 p.m. — page charge CRNA *7853 to ask for relief at 3:45 p.m.)
*These are mandatory sessions*
Mon (5/15): Garrett, Li
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.
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?
Personal Assistance Service (PAS) is the faculty/employee assistance program of Duke University, that is FREE. The staff of licensed professionals offer assessment, short-term counseling, and referrals to help resolve a range of personal, work, and family problems. PAS services are available at no charge to Duke faculty and staff, and their immediate family members. An appointment to meet with a PAS counselor may be arranged by calling the PAS office at 919-416-1PAS (919-416-1727), Monday through Friday between 8:00 A.M. and 5:00 P.M. If you need assistance outside of those hours, call the Blood and Body Houtlins (684 1115) for behavioral health concerns.
This Week in Lectures
CA 1 (5/16): No Lecture
CA 2/3 (5/17): Geriatric Jeopardy with Dr. Ellen Flanagan
Thursday (5/18): Journal Club with Dr. Ankeet Udani
Next Week in Lectures
CA 1 (5/23): Managing Diabetes with Dr. Beatrice Hong
CA 2/3 (5/24): Efficiency in Ambulatory Surgery with Dr. Stephen Klein
Thursday (5/25): Basic Recognition of Congenital Heart Disease in the Adult with DR. Brandi Bottiger
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!