In the image above, the pulsus bisferiens (panel A) developed acutely on the first postoperative day in a patient on peripherally placed extracorporeal membrane oxygenation (ECMO). ECMO was started intraoperatively because of the inability to separate from cardiopulmonary bypass because of profound vasoplegia after aortic valve replacement. Pulsus bisferiens is a feature of severe aortic regurgitation. It shows two upstrokes of arterial pressure trace during systole and wide pulse pressure may concomitantly be present.1 A similar waveform may also be visible in hypertrophic obstructive cardiomyopathy, severe mitral valve prolapse, and sepsis. In our patient, severe aortic regurgitation was confirmed with transesophageal echocardiogram (panel B) that showed holodiastolic retrograde flow in the descending thoracic aorta and aortic regurgitation with Doppler (panel C). It is essential to promptly diagnose acute aortic regurgitation in patients on...
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Images in Anesthesiology| February 2021
Pulsus Bisferiens on Extracorporeal Membrane Oxygenation
Muhammad Salman Tahir Janjua, M.B.B.S. ;
Shikha Shukla, M.D. ;
From the Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (M.S.T.J., H.T.); and the Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York (S.S.).
Correspondence, Address correspondence to Dr. Tahir Janjua: email@example.com
Anesthesiology Newly Published on February 2021. doi:
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Muhammad Salman Tahir Janjua, Shikha Shukla, Hossam Tantawy; Pulsus Bisferiens on Extracorporeal Membrane Oxygenation. Anesthesiology Newly Published on February 1, 2021. doi: https://doi.org/10.1097/ALN.0000000000003697
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