Anesthetic considerations for cesarean section in the parturient with familial cardiomyopathy.

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by ventricular dilatation and impaired systolic cardiac function. DCM is defined by the presence of: a) fractional myocardial shortening less then 25% (> 2 SD) and/or ejection fraction less than 45% (> 2 SD); and b) left ventricular end diastolic diameter (LVEDD) greater than 117% excluding any known cause of myocardial disease. Familial dilated cardiomyopathy (FDC) accounts for 20-48% of all DCM cases, and is defined by the presence of two or more affected relatives with DCM meeting the above diagnostic criteria or a relative of a DCM patient with unexplained sudden death before the age of 35 years. We herein present the first reported case in the literature of a parturient with FDC undergoing urgent Cesarean section (secondary to worsening cardiac function) and briefly highlight anesthetic considerations for parturients with this heart condition.

Congenital longitudinal deficiency of the fibula: follow-up of treatment by Syme amputation.

Congenital longitudinal deficiency of the fibula presented two major problems in management: severe shortening of the limb and equinovalgus deformity of the ankle and foot. When the deformity was severe, our attempts at reducing the deformities of the foot and ankle with soft-tissue procedures and our attempts at achieving limb-length equality with various lengthening procedures were unsuccessful. Our best results in these patients were achieved with an early Syme amputation. The pattern of the deformity and the determination of the growth inhibition factor in the involved limb now enable us to make an early estimate of the deformity and plan appropriately. Syme amputation is definitive and allows the patient to have nearly normal function of the limb and a prosthesis of excellent appearance.