Dynamic left ventricular outflow tract obstruction complicating aortic valve replacement: a hidden malefactor revisited

It is known that a dynamic left ventricular outflow tract [LVOT] obstruction exists in patients, following aortic valve replacement [AVR] and is usually considered to be benign. We present a patient with dynamic LVOT obstruction following AVR, who developed refractory cardiogenic shock and expired inspite of various treatment strategies. This phenomenon must be diagnosed early and should be considered as a serious and potentially fatal complication following AVR. The possible mechanisms and treatment options are reviewed

Management of sickle cell disease during CABG surgery - A case report

Elective Coronary Artery Bypass Graft [CABG] surgery using cardiopulmonary bypass techniques following preoperative transfusions to increase the hemoglobin A levels to above 60%, in a male patient with sickle cell disease [SCD] is described. Avoidance of hypoxia and acidosis lead to an uneventful perioperative period. Our institutional protocol for preoperative transfusions is highlighted

Novel technique for off pump bidirectional glenn shunt -safety issues- a case report

A new technique to decompress the superior vena cava [SVC] during off pump bi-directional Glenn [BDG] shunts is described. Cerebral protection maneuvers and the safety concerns of the technique are addressed

Ventricular septal defects with pressure-overloaded right ventricle haemodynamic challenges

The right ventricular function is compromised in the presence of severe pulmonary hypertension and/or severe right ventricular outflow obstruction. Evolution in the medical and surgical management has improved the outcome in pressure overloaded right ventricle [RV]. This report describes two patients, aged 16 and 4 years. Echocardiogram and cardiac catheterisation revealed a large sub aortic ventricular septal defect [VSD] with elevated pulmonary artery pressures [PAP] in the first case, and pulmonary atresia, VSD, double outlet right ventricle, severely hypoplastic LPA, and a functioning Blalok Tausig shunt in the second case. The anaesthetic challenges of RV support are described, as well as the surgical technique in VSD repair, using valved patch closure to act as a pressure release valve to decompress the RV during hypertensive episodes. An innovative surgical technique for patients with over loaded RV, which were hitherto considered inoperable, is illustrated, emphasizing the role of anaesthetic management