June 7, 2017
We’re almost to the end of the academic year! This time of year is exciting as the academic year comes to an end and is jam-packed as conferences occur, graduations take place, and year-end celebrations transpire. Two weeks ago, I was in Atlanta for SCA’s ECHO Week, followed by a quick trip to UCSF to take part in the first ‘Celebrating Women in Anesthesia.’ I had the opportunity to join a panel with Drs. Sue Carlisle, Harriet Hopf and Jeanine Wiener-Kronish, where we spoke about our careers and the paths we took to get there. It was a great event to continue the conversation of women leaders in anesthesiology.
Thank you to all who joined us to celebrate the house staff and faculty at the Durham Bulls game this past weekend. The Paw Sox won, but it was a great night for all and the fireworks were definitely the highlight of the week for my kids. The fellows were celebrated at their graduation the following day at the Washington Duke Inn, and the interns are on vacation this week in preparation for their transition to anesthesia with the start of CA-1 orientation on Monday. The other residents have not been left out: mock orals are next Tuesday and of course, graduation on Saturday, June 17th! Hope to see you all there!
Did you know the Clinical Dashboard is live and updated every Saturday night? Make sure to check out your clinical dashboard! Download the free table Tableau Reader here for quick access. Once you log in with your usual net id and password, you’ll see a black screen. Click on yourself in the drop down menu on the right side of the screen, you’ll be able to see PACU length of stay, ASA classes, number of records per service and over time, as well as anesthesia techniques and OR hours over time. We’ll be adding more clinical data over time, so be sure to check back often. The data is updated automatically through EPIC every Saturday night. Save this link https://tableau-ace.dhe.duke.edu/#/site/Anesthesiology/projects to access your dashboard.
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!
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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!