Perioperative implications of Coronary–cameral fistula

Coronary–cameral fistulas (CCFs) are mostly congenital in origin and rarely acquired. Clinical symptoms are decided by the hemodynamic significance of the coronary fistula. Even in asymptomatic patients, it is essential to know about coronary CCF particularly if the patient is to undergo cardiac surgery with cardioplegic cardiac arrest. Incidental finding of coronary CCF should never be ignored. Intraoperative myocardial protection and methods used are significantly influenced by such fistula.

Ipsilateral foot drop after aortobifemoral bypass

Peripheral nerves can be injured by a direct result of the anesthetic technique of regional anesthesia or it can be contributed/compounded by poor perioperative positioning and padding, tourniquets, and the nature of surgery and diseases affecting the microvasculature of nerves. We present a case of perioperative peripheral nerve injuries which could not be explained by anesthesia technique nor surgery per se.

Sudden, new-onset aortic regurgitation during off pump coronary bypass surgery

During off pump coronary artery bypass grafting surgery, it is common to observe mitral or tricuspid regurgitation due to heart displacement. But it's very unusual to notice new onset aortic regurgitation in OPCABG.

Sudden appearance of new clot

A patient having mitral stenosis with chronic atrial fibrillation, large left atrium, and spontaneous echo contrast is expected to have clot in LA or LAA. TEE is more sensitive to detect thrombus in LA and LAA than transthoracic echocardiography. However, false-negative results can still occur due to multilobed LAA, and a thrombus can be potentially missed.

Massive subcutaneous emphysema after off-pump coronary bypass surgery

Subcutaneous emphysema is a condition when air gets accumulated into the tissues under the skin and in the soft tissues of the chest wall or neck but can also spread to other parts of the body. It generally causes minimal symptoms and nonlethal; sometimes, it may be severe and life-threatening if deeper tissues of the thoracic outlet and chest are involved. It is essential to know the mechanisms of subcutaneous emphysema after cardiac surgery.

Aortic regurgitation after chemoport catheter insertion: Diagnostic dilemma

Catheter insertion in central vein can potentially cause accidental arterial injury. However it is very unusual to see such catheter in aorta causing aortic regurgitation. Pressure monitoring and Ultrasound guidance can reliably prevent accidental arterial puncture.

A curious case of raised gradient across mitral bioprosthetic valve

High Doppler valve gradient is generally suggestive of valve thrombosis. However, it should be corroborated with the finding of restricted leaflet movement to confirm the diagnosis. In the present case, abnormally high gradient was not associated with limited leaflet movements or any valve thrombus.

Superior vena cava clamping during thoracic surgery: Implications for the anesthesiologist

Resection and reconstruction of the SVC is a challenging Intraoperative situation owing to the potential complications after clamping a patent vessel. Hemodynamic imbalance and neurological effects of SVC clamping can be life threatening. These complications can be prevented by careful intraoperative monitoring and management. Anaesthesiologist must be aware of different options to manage such challenging situations.

Undiagnosed aortic dissection in patient with intra‑aortic balloon pump.

60 years old lady presented with chest pain and was admitted in local hospital. Electrocardiogram was suggestive of anterior myocardial ischemia. Patient underwent coronary angiography which revealed severe triple vessles coronary artery disease. As patient was hemodynamically unstable and in cardiogenic shock, intraaortic balloon pump was inserted .IABP augmented diastolic blood pressure was less than unassisted systolic blood pressure despite setting maximum augmentation on IABP machine.

Rare postoperative delayed malignant hyperthermia after off‑pump coronary bypass surgery and brief review of literature.

Postoperative malignant hyperthermia (MH) is a very rare phenomena. It is generally observed within less than an hour after discontinuation of the anesthetic trigger. Present case describes rare delayed postoperative presentation of MH after off‑pump coronary bypass surgery. Prompt recognition and immediate treatment with dantrolene can effectively treat the fatal syndrome. Family education and genetic counseling should be encouraged.