A&A practice
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A 19-year-old man with mitral valve endocarditis and prolapse, intracerebral and intracerebellar hematoma, and a mycotic cerebral aneurysm underwent emergency mitral valve replacement during minimal cardiopulmonary bypass (total priming volume, 800 mL; autologous retropriming, activated clotting time <300 seconds) 1 day after undergoing endovascular coil embolization of the aneurysm. Postoperatively, there were no extensions of the intracerebral and intracerebellar hematoma. After intensive rehabilitation therapy, the patient recovered fully except for residual bilateral claudication because of preoperative bilateral embolism to both superficial femoral arteries.
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We present a case of maternal cardiac arrest during an elective cesarean delivery. Transesophageal echocardiography identified a large pulmonary artery mass, and guided resuscitation efforts. ⋯ Correction of coagulopathy was observed clinically and confirmed by rotational thromboelastometry. The patient fully recovered without neurological deficit.
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Postintubation subglottic stenosis is one of the most common causes of stridor in newborns and babies after prolonged mechanical ventilation. Management of this pathology is complex and requires highly trained personnel because it is associated with a high rate of airway-related mortality. This article presents the rescue of a difficult airway in a pediatric patient with subglottic stenosis with a new device available on the market, the Ventrain, offering certain advantages over those available until now.
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We present 2 infants with the rare association of long congenital tracheal stenosis, ventricular septal defect, and pulmonary hypertension. We describe a step-by-step assessment of the patients and the necessary procedures for a successful concomitant repair of both cardiac and tracheal malformations. The use of a helium-oxygen mixture (heliox) for the induction of anesthesia and pre-cardiopulmonary bypass is discussed.
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Anaphylactic reaction to gelatin-containing hemostatic agents has been reported in the orthopedic literature, most commonly during scoliosis repair in adolescents. However, the risk, differential diagnosis, and management of anaphylaxis in patients with complex congenital heart disease undergoing noncardiac procedures have not been previously reported. We describe the case of an adolescent with a history of repaired truncus arteriosus undergoing posterior spinal fusion who developed sudden and profound hypotension that was ultimately confirmed to be an anaphylactic reaction to Surgiflo. Echocardiography was used to aid in diagnosis and management of the cardiovascular effects of anaphylaxis in this patient with residual cardiac pathophysiology.