Mitral valve repair complicated by left circumflex coronary artery occlusion: The vital role of the anesthesiologist.

The anatomical relationship between the mitral valve and the left circumflex coronary artery places this vessel at risk for occlusion during mitral valve repair or replacement. In view of the potential high morbidity and mortality of this complication, the anesthesiologist has a vital role in its prompt diagnosis. We present the case of a 47-year-old man who underwent a minimally invasive mitral valve repair, which was complicated by left circumflex coronary artery occlusion.

Unicuspid aortic valve: Case series and review.

A unicuspid aortic valve is a very rare valvular lesion. Its physical manifestations vary and are associated with other cardiovascular abnormalities such as aortic stenosis/insufficiency and aortopathy. Echocardiography remains the modality of choice, with computerized tomography or cardiac magnetic resonance used as adjunctive imaging. Herein, we present a case series of three patients with unicuspid aortic valves treated at our institution, with a focus on 2D and 3D echocardiographic imaging.

Persistent left superior vena cava identified by transesophageal echocardiography.

A 70-year-old female with severe aortic stenosis presented for aortic valve replacement and underwent routine preoperative Swan-Ganz catheter placement. Transesophageal echocardiography demonstrated a dilated coronary sinus with a catheter present. A high suspicion of venous anomaly prompted an agitated saline study. Flow through the coronary sinus into the right atrium was observed, confirming the presence of a persistent left superior vena cava. Although the persistent left superior vena cava has a low prevalence in the general population, it is one of the most common thoracic venous anomalies. During central venous cannulation, the presence of venous anomalies increases procedural complication rates. Fortunately, our patient remained asymptomatic both before and after catheter insertion. Awareness of this anomaly could help clinicians avoid complications.

Acute Adrenal Insufficiency After an Antiemetic Dose of Dexamethasone: A Case Report.

Dexamethasone is widely used in current practice for the prevention of postoperative nausea and vomiting. Although its use in the perioperative setting has been associated with several side effects (eg, hyperglycemia and suppression of adrenal cortisol production), their clinical significance remains questionable. We present the case of a healthy 27-year-old woman who developed acute adrenal insufficiency after receiving intraoperative dexamethasone for postoperative nausea and vomiting prophylaxis during a laparoscopic left oophorectomy.

Papillary Fibroelastoma Found With Transesophageal Echocardiography After a Normal Transthoracic Echocardiography.

We present the case of a patient with transient ischemic attacks who was being investigated for multiple embolic strokes. Initial workup, including brain computed tomography, computed tomography angiography, and transthoracic echocardiography (TTE) were negative for a source until transesophageal echocardiography (TEE) found a mass in the left atrium. The TEE differentiated the mass as a rare cardiac papillary fibroelastoma on the left atrial free wall confirmed by postsurgical pathology. This case highlights the importance of TEE as a diagnostic tool for its ability to more accurately differentiate and characterize the tumor compared with TTE. This case underscores that a negative TTE does not equate to zero risk of the presence of a cardiac tumor. It is prudent for the clinician to be cognizant that it may be beneficial to perform a TEE even with a negative TTE workup.