Arun Maheshwari

Stuck suction catheter in endotracheal tube

Endotracheal tube (ETT) suction is essential to clear secretions so that airway patency can be maintained. Stuck suction catheter in ETT is an uncommon event, and it can be dangerous in patients with difficult airway cases.

Left ventricular mass: myxoma or thrombus?

Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart. In either case, mobile mass with embolic potential should be surgically resected.

Malposition of a nasogastric tube

Failure to identify a malpositioned NGT may lead to fatal pulmonary complications. Hence, it is essential to confirm radiographically before starting enteral feeding or medications. Mostly narrow lumen tubes with stiff inner guide wire have been reported in the malposition complication.[6] In the present case, we had a malposition of large bore 14 French gauge nasogastric tube without guide wire. Inadequately inflated ETT cuff may have been the reason for the passage of NGT in trachea as cuff pressure was not monitored. While inserting NGT, confirm cuff of ETT adequately inflated and NGT can be directed to esophagus under direct laryngoscopic vision with the help of Magill’s forcep (Manufacturer ‐ Anaesthetics). After placing NGT, epigastric auscultation can mislead about the positioning as, in this case. However, checking for the air coming out of the outer end of NGT and confirming it by seeing air bubbles with every expiration of the patient when outer end of The Editor,

Intraoperative detection of stuck leaflet of prosthetic mitral valve

[50_TD

Empagliflozin: Novel antidiabetes and pro-cardiac drug

DIFF]Bileaflet prosthesis valves are the most commonly used mechanical valves. Dysfunction of bileaflet prosthesis valve is rarely observed. Pannus and thrombus can obstruct prosthesis valve in postoperative period over a period of time. Here we present a rare case of intraoperatively diagnosed prosthesis valve dysfunction along with review of different mechanism causing such complication. 50 years male presented with severe shortness of breath at rest and fever since 15days. He was already on antibiotics when he was referred to our center for further management.He was thoroughly evaluatedandechocardiographyshowedseveremitral regurgitation with vegetation on posterior mitral leaflet bouncing in left atrium. Considering high embolic potential of the lesion, patient was urgently scheduled for open heart surgery for removal of lesion and correction of mitral regurgitation. After smooth anaesthesia induction, transesophageal echocardiography (TEE)was performed and it revealed 1.2 square cm mobile mass on the posterior mitral leaflet. (Fig. 1, clip 1) Severe mitral regurgitation was observed due to noncoaptation of mitral leaflets. (Fig. 2, clip 2) After instituting cardiopulmonary bypass, mass with mitral leaflets were resected and sent for bacterial and fungal cultures. OnX 25mm bileaflet prosthetic mechanical mitral valve was inserted. While weaning frombypass, TEE revealedone stuck leafletof prostheticmitral valve in semiclosed position, where as other leafletwasmoving normally. (Fig. 3, Clip 3,4) As the cardiac outputwas low even after optimizing loading conditions, it was decided to reinstitute cardiopulmonary bypass again. After achieving cardioplegic arrest of the heart, prosthetic valvewas examined. Both leaflets could be easily opened with cotton tipped swab. We assume that subvalvular tissue might be obstructing themovement of one leaflet. So, prosthetic valvewas rotated by 90 with the rotator. TEE showed normal movements of both leaflets of prosthetic valve. (Fig. 4, Clip 5) Hemodynamicswere stable and patient was easily weaned from bypass. Postoperative course of the patient was uneventful. Bileaflet prosthetic valves are most commonly used mechanical valves due to their good hemodynamic performance and low incidence of valve complications.[51_TD

Awareness of Kounis Syndrome, a Takotsubo-Like Syndrome, by a Cardiovascular Anesthesiologist.

DIFF] Thrombosis and pannus can causeprostheticvalvedysfunctioninpostoperativeperiodoveradue course of time.[52_TD

Left atrial myxoma with biventricular dysfunction

DIFF] –4 However, Intraoperative mechanical valve dysfunction is rare event with potentially fatal complication.[53_TD

Eustachian valve - Masquerading ASD rim

DIFF] –8 Such complication has been reported more commonly with metallic prosthetic valves than bioprosthetic valves. Obstruction causing stuck valve can be intrinsic or extrinsic. Intrinsic obstruction is caused by inherent defects in manufacturing of the valve or defects due to wear. [54_TD

Stress cardiomyopathy and other resembling conditions

DIFF]9 Manufacturing defect in BjorkShiley valve resulting in sticking of the occluder disc in the closed position has been reported. [55_TD

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

DIFF]10 However with continuous improvement in prosthetic designs and materials, incidences of intrinsic failure have decreased over a period of time. Extrinsic obstruction is caused by mitral subvalvular apparatus or suboptimal orientation and mechanical obstruction by suture. [56_TD