Vital Signs
Annemarie Thompson, MD

Dr. Annemarie Thompson
Residency Program Director

May 23, 2018

Sarah Cotter, MD

Sarah Cotter, MD

Good times – spring blossoms, graduations, and of course, the annual Duke Anesthesiology Durham Bulls event!  For those of you who missed the victory, the food, the cool spring evening, and the fireworks, we’ve attached some pictures.

Great news! The new resident lounge in Duke Medicine Pavilion (yes, you read that right – new lounge, DMP 2W02) is now open! For the past year, we have worked with the Duke Health Facility Planning, Design and Construction team to renovate a space for our residents on the DMP platform. We are thrilled that in addition to our newly renovated lounge in HAFS, the DMP lounge will provide our residents with much needed space to relax, study, and work on daily administrative needs.  Please join me in thanking both the former and current presidents of Duke University Hospital, Mr. Kevin Sowers and Dr. Thomas Owens, for their encouragement and support of this project. I would also like to thank Dr. Joseph Mathew, Clif Flintom, and Becky McKenzie for their unwavering commitment to making the new resident lounge a reality.

RJ Krom, MD

RJ Krom, MD

Now for a few “shout outs” to our residents:  Dr. Julien Cobert won 1st place in the Excellence and Innovation category at the 33rd Annual SAMBA Meeting in May for a study titled, “The Effect of Tourniquet Pressure on Tissue Oxygenation using the Oxyneurography Technique.” Dr. Sarah Cotter received one of the SCA resident/fellow travel grants to present her SCA Best of Abstract at the 2018 SCA annual meeting in Phoenix, Arizona. In the teamwork category, while enjoying a rare break in cardiac cases, Dr. John McManigle sprang into action to help out the team on OB during an emergency. And Dr. RJ Krom, one of our interns, was a finalist for the Physician Partner Award at Duke Regional Hospital given by the Nursing Partners in Practice.

Don’t forget two important upcoming events: Academic Evening is next Tuesday, May 29th at the Millennium Hotel with our honored guest and visiting professor, Dr. Sean Mackey from Stanford University.  And lastly, please remember to RSVP for our Resident Graduation Banquet to be held June 9th at 5:30 p.m. in the Delta Suite at Wallace Wade Football Stadium.

Have a great week! ~ AMT

Angela Pollak, MD
Alison Brown, MD

Presented at 2018 SCA

“Surgical Resection of Massive Intraventricular Cardiac Hydatid Cyst Complicated by Severe TR, RV Failure, and VSD”

Angela Li, MD, Sharon McCartney, MD, Alison F. Brown, MD, Cory Maxwell, MD, Jacob Schroder, MD

Introduction: Ingestion of the larval stage of the parasite Echinococcus granulosus via contaminated food, water, or soil leads to formation of hydatid cysts.[1] Cysts commonly present in the liver and lung, but <2% present in the heart. Cardiac cysts have a predilection for the left ventricle (55-60%) and intraventricular (IV) septum (10-20%). The location of the cyst, the presence of cyst rupture, and mass-effect determines symptomatic presentation, commonly nonspecific EKG changes.[2,3] Contrary to cysts in other locations, surgery is mandatory even for asymptomatic lesions.[3] Operative management prevents cyst rupture and larval embolization which results in life-threatening anaphylaxis. We describe cardiac echinococcosis of the IV septum that presented with syncope due to mass effect mimicking hypertrophic cardiomyopathy.

Case Presentation: A 47-year-old Sudanese male presented following 6-months of chest pain and syncope. An ECG showed non-specific T wave inversions, with a stress test negative for ischemia. CT evaluation revealed a 5 x 5 x 4.7 cm septal mass, then confirmed by transthoracic echocardiography. MRI confirmed a cystic mass concerning for cardiac echinococcosis given exposure to endemic regions. Albendazole therapy was initiated, and the decision was made for surgical resection.

After median sternotomy and initiation of cardiopulmonary bypass (CPB) the hydatid cyst was removed via a right ventriculotomy. Prophylactic famotidine, diphenhydramine, and methylprednisolone was given in case of cyst rupture. The cyst was wrapped in hypertonic 20% saline soaked gauze, then 95% EtOH to decrease parasite load and prevent cyst rupture. The cyst and septum were resected enbloc requiring patch closure of the ventricular septal defect (VSD). On initial wean from CPB, obstruction of the right ventricular outflow tract and severe tricuspid regurgitation mandated bioprosthetic tricuspid valve replacement and septal VSD revision. The total cross clamp time was 42 minutes and the total CPB time was 364 minutes.

The postoperative course was complicated by hemorrhage, prolonged mechanical ventilation, acute renal injury, and severe right ventricular (RV) dysfunction requiring inotropes, intra-aortic balloon pump, and right ventricular assist device (RVAD). On postoperative day (POD) 45, the RVAD was explanted. The patient was discharged home on POD 103 and returned to his job. He is followed in heart failure clinic for small, residual VSD.

Discussion: Cardiac echinococcosis is an exceptionally rare diagnosis, making up 0.5% to 2% of all hydatid infections. Surgery is the treatment of choice even for asymptomatic cardiac hydatid cysts.[3] Both medical and surgical management were necessary to treat this complicated cyst and transesophageal echocardiography was key to guiding safe and complete excision of a large hydatid cyst located in the heart.

Drs. Jack Gamble and Angela Pollak

CENTRAL LINE :: 5/21/2018 – 5/27/2018

Weekend Days
This weekend (5/26 – 5/28): Levine, La Colla
Next weekend (6/2 – 6/3): Cobert, Lane

Night Float
This week (5/19 – 5/24): Horazeck, Frangakis
Next week (5/26 – 5/31): Van Hoomissen, Wong

Friday Night
This Friday (5/25): Wang, Brown
Next Friday (6/1): Mintz-Cole, Schiller

Liver Call Weekend (pager: 970-7320)
This weekend (5/26 – 5/28): Ellison
Next weekend (6/2 – 6/3): Chen

Liver Call Weekday (pager: 970-7320)
Liver day (Mon 5/21 – Fri 5/25): Donald
Liver night (Mon 5/21 – Fri 5/25): Brockbank

Liver day (Tues 5/29 – Fri 6/1): Ellison
Liver night (Tues 5/29 – Fri 6/1): Levine

OB Weekend
Saturday 5/26 AM: Devinney
Saturday 5/26 PM: Pleticha
Sunday 5/27 AM: Fox

Saturday 6/2 AM: J. Anderson
Saturday 6/2 PM: Johnbull
Sunday 6/3 AM: Ellison

ASC Fridays
This Friday (5/25): Wong
Next Friday (6/1): Schiller

Simulator (4-6pm—page charge CRNA *7853 to ask for relief at 3:45pm)
*These are mandatory sessions* Please remind each other.
6/4: Bach, Lamb, Roberts, Wong
6/11: J. Anderson, Brown, Horres, Frangakis
6/18: La Colla, Schiller, Yan
6/25: Lane, McManigle, Sharma

Functional Pagers
CA3 on call pager (970-9313) is covered by CA3 on general OR call.
Liver call pager (970-7320) is always covered.
PACU CA3 pager (970-5325)

Please let me know if any errors/omissions!

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): June 13th 1 p.m. and June 26th 1 p.m. in HAFS office.

Dr. Brian Colin and Dr. Ankeet Udani (Assistant Program Directors): Per request.

Jessica Burkhart (Senior Program Coordinator): Monday – Friday, 8 – 4 p.m. in HAFS office

Shelby Schultz (Junior Program Coordinator): Monday – Friday, 8 – 4 p.m. in HAFS office

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.

Wellness Opportunities
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 offers 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. Four premium time appointment slots are being offered each week for GME trainees only. Two appointments are at 7 am (Tuesdays and Fridays), and two appointments are at 5 pm (Mondays and Wednesdays), each week.

24 x 7 behavioral health support for GME trainees, including urgent support for those experiencing behavioral health crises during nights and weekends: During normal business hours, and for non‐urgent behavioral health care needs, PAS (919‐416‐1727), Duke Psychiatry (919‐684‐0100) or Employee Health (919‐684‐3136) are resources to access timely behavioral health care.

This Week in Lectures

CA 1 (May 22): Determinants of Coronary Blood Flow with Yasmin Maisonave, MD

CA 2/3 (May 23): IV Regional Anesthesia with Steve Melton, MD

Thursday (May 24): FOCUS with Mandisa Jones-Haywood, MD (CA 2/3 ONLY)

Next Week in Lectures

CA 1 (May 29): Academic Evening – Please join us!

CA 2/3 (May 30): Head and Neck Blocks with Hector Martinez-Wilson, MD, PhD

Thursday (May 31): FOCUS with Mandisa Jones-Haywood, MD (CA 2/3 ONLY)

To view the complete list of job postings, visit the Box Account. Email Shelby or Jessica to get added!

Duke Anesthesiology Residency Program

Department of Anesthesiology

GME Mistreatment Reporting Site

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