AHA ACC Class Class Class Class critical 1 High risk 4 METS Canadian Class 2 Canadian Class Q 3 ST-T S3 11

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1 Guidelines for perioperative cardiovascular evaluation and management for noncardiac surgery (JCS 2003) Circulation Journal Vol. 67, Suppl. IV,

2 AHA ACC Class Class Class Class critical 1 High risk 4 METS Canadian Class 2 Canadian Class Q 3 ST-T S3 11 ECG 7 5PVC 7 PaO2 60 mmhg 3 PaCO2 50 mmhg 3 K+ 3 meq l 3 BUN 50 mg dl 3 Creatinine 3 mg dl Class0 5 1 % Class % Class % Class26 22 % 1240 Circulation Journal Vol. 67, Suppl. IV, 2003

3 % 3 3 Class Class % ST segment 3 2 cost-effective cardioversion Circulation Journal Vol. 67, Suppl. IV,

4 ACC AHA 110 mmhg 4 40 ** pneumatic compression 40 8 pneumatic compression 40 pneumatic compression INR INR pneumatic compression 1 2 pneumatic compression 1 2 INR pneumatic compression pneumatic compression pneumatic compression duplex ultrasonography pneumatic compression *Clagett et al. ** 1242 Circulation Journal Vol. 67, Suppl. IV, 2003

5 4 5 fi CABG PTCA patient-controlled analgegiapain score Hypovolemia fl 3 off-pump bypass hypovolemia X hypovolemia Circulation Journal Vol. 67, Suppl. IV,

6 hypovolemia ST 34 7 X CT CT 3 1 NYHA mmhg 25 mmhg mmhg 80 mmhg 3 60 % 80 % Eisenmenger Marfan 90 % 85 % 9 Fontan Ebstein Ebstein 1244 Circulation Journal Vol. 67, Suppl. IV, 2003

7 % % a aptt INR a 4 low-profile 17,500 20,000U aptt 2 3 b b a 2 a a Circulation Journal Vol. 67, Suppl. IV,

8 g 1.5mg kg 80 mg g 1.5 g g mg kg 80 mg g g 8 8 Apgar 1 2 ACE Circulation Journal Vol. 67, Suppl. IV, 2003

9 1 1 X PTCA 6 5 CABG CABG 2 or 30 CCSor CCS or Q 4METs 4METs 4METs 4METs 1 Circulation Journal Vol. 67, Suppl. IV,

10 PTCA off-pump CABG MIDCAB IABP IABP IABP 3 5 NLA 2 Levine 1 50 mmhg 2 60 % 1248 Circulation Journal Vol. 67, Suppl. IV, 2003

11 2 X 50 mmhg 1.0 cm 2 50 mmhg 1.0 cm 2 50 mmhg 1.0 cm 2 50 mmhg 1.0 cm 2 fi 1.5 cm 2 PTMC OMC MVR 3 fl 1 CRP PT-INR 3 2 Circulation Journal Vol. 67, Suppl. IV,

12 X 2.0cm 2 2.0cm 2 PTMC 1 MR 3 4 PTMC OMC OMC MVR PTMC minor surgery % 43 % % % % % 1250 Circulation Journal Vol. 67, Suppl. IV, 2003

13 E g kg 2 Baum 1 11 Glenn 4 1 ACC AHA Holter 9 1. Eisenmenger 2 3 Circulation Journal Vol. 67, Suppl. IV,

14 mmhg mmhg 70-mmHg mmhg mmhg mmhg mmhg 100 mmhg 90 mmhg Qp Qs Fontan 10 6 Fallot Eisenmenger 11 AHA AMPC 3g 1 AMPC 1.5g 6 2 AMPC 2g GM 1.5mg kg 30 AMPC 1.5g 1.5g 6 3 AMPC penicillin EM 1 g 1 EM 0.5g 6 CLDM 300mg 1 CLDM 150mg AMPC 2g GM 1.5mg kg 30 AMPC 1.5g 6 2 AMPC penicillin VCM 1g GM 1.5mg kg AMPC 3g 1 AMPC 1.5g CT MRI 1252 Circulation Journal Vol. 67, Suppl. IV, 2003

15 12 6cm a 5cm Marfan 5cm 6cm 5mm 6 b 4cm 5cm b A 6cm 5mm 6 a Marfan b A 5 6cm CT A B 6 cm % CRP Marfan IABP Circulation Journal Vol. 67, Suppl. IV,

16 A 6 cm 6 cm a 5 cm Marfan 5 cm 6 cm 5 mm 6 Marfan b 4 cm 5 cm 5 cm 6 cm off-pump CABG hybrid 6 ASO Circulation Journal Vol. 67, Suppl. IV, 2003

17 ASO cm 70 % ASO 5 6 cm % 5 cm 49 % cm 6 cm 3 29 % FDP DIC 5 2 TIA TIA mmhg mmhg TCPO mmhg 7 1 X 2 4 S1Q3T3 S1S2S3 Circulation Journal Vol. 67, Suppl. IV,

18 mmhg CO2 O2 PPH PTE NO DPD PGI2 prostacyclin % INR PCPS % % 8 WHO ISFC cardiomyopathy % NYHA EF 20 % 20 % EF 40 % 40 % EF 1256 Circulation Journal Vol. 67, Suppl. IV, 2003

19 6 LVEF 20 % 20 % 40 % 40 % -blocker catecholamine LVAS PDE volume volume volume Mobitz stimulant 14 hypovolemia Ca++ PAC PVC K Ca Circulation Journal Vol. 67, Suppl. IV,

20 ICD AOO VOO DOO ICD shock delivery ICD ICD ME Detsky AS, Abrams HB, McLaughlin JR, et al: Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med 1986; 1: Hollenberg M, Mangano DT, Browner WS, et al: Predictors of postoperative myocardial ischemia in patients undergoing noncardiac surgery: The Study of Perioperative Ischemia Research Group. JAMA 1992; 268: Mangano DT, Browner WS, Hollenberg M, et al: Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery: The Study of Perioperative Ischemia Research Group. N Engl J Med 1990; 323: Goldman L, Caldera DL, Nussbaum SR, et al: Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: Clagett GP, Anderson FA Jr, Levine MN, Salzman EW, Wheeler HB. Prevention of venous thromboembolism. Chest 1992; 102 (suppl 4): 391S-407S 6 Cohen MM, Duncan PG, Tate RB. Does anesthesia contribute to operative mortality? JAMA 1988; 260: Williams JS, Graff JA, Uku JM, Steinig JP. Aortic injury in vehicular trauma. Ann Thorac Surg 1994; 57: Elkayam U. Pregnancy and cardiovascular disease. In: Braunwald ed. Heart disease. A textbook of cardiovascular medicine. 5th ed. Philadelphia, Pa. WB Saunders. 1997, p Presbitero P, Somerville J, Stone S, Aruta E, Spiegelhalter D, Rabajoli F. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation 1994; 89: ACC AHA guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 1998; 32: Baum VC, Barton DM, Gutgesell HP. Influence of congenital 1258 Circulation Journal Vol. 67, Suppl. IV, 2003

21 heart disease on mortality after noncardiac surgery in hospitalized children. Pediatri 2000; 105: : 1994; 9: Dajani AS, Taubert KA, Wilson W, Bolger AF, Bayer A, Ferrieri P, Gewitz MH, Shulman ST, Nouri S, Newburger JW, Hutto C, Pallasch TJ, Gage TW, Levison ME, Peter G, Zuccaro G Jr. Prevention of bacterial endocarditis; recommendation by the American Heart Association. Circulation 1997; 96: Proctor MC, Greenfield LJ: Thromboprophylaxis in an academic medical center. Cardiovasc Surg 2001; 9: P. Richardson, W. McKenna, M. Bristow, B. Maisch, B. Mautner, J. O Connell, E. Olsen, G. Thiene: Report of the 1995 World Health Organization International Society and Federation of Cardiology Task force on the definition and classification of cardiomyopathies. Circulation 1996, 93: Circulation Journal Vol. 67, Suppl. IV,

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