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CASE 9-2016: Management of a Former Cardiac Anesthesiologist With Increasing Aortic Stenosis Requiring Aortic Valve Replacement.

RANSTHORACIC ECHOCARDIOGRAPHY (TTE) is an important tool for evaluating and managing patients with worsening aortic stenosis. In almost every case, imaging is performed by a sonographer and interpreted by a cardiologist. It is rare for a patient’s cardiac pathology to be followed by an anesthesiology echocardiography team that performs and interprets the patient’s frequent TTE imaging and works as a team with the patient’s cardiologist. The authors describe a case of mild aortic stenosis discovered in a 70-year-old former cardiac anesthesiologist (T.S.) during a routine physical examination by his primary care physician (an internist/cardiologist). The aortic stenosis then was followed for 5 years by the anesthesia echocardiography team with frequent TTEs (ie, every 3-6 months) until the severity of the stenosis indicated valve replacement was required even though the patient’s symptoms were subtle and mild. Intraoperative echocardiography is an increasingly important tool, and it is now an accepted practice for anesthesiologists to perform transesophageal echocardiography (TEE) during surgery. While most anesthesia echocardiography is transesophageal, for those with sufficient skill and training, TTE can be put to good use in managing patients throughout the perioperative period, from the preoperative clinic through hospital discharge. 1 Although cardiologists usually follow patients with cardiac pathology that may require surgical correction, because of their skill and experience with TTE, some anesthesia echocardiography teams may be asked to assist in the followup imaging, management, and decisions these patients need to make about their subsequent surgical care.