The Gerbode defect was first described in the late 1950s as a congenital peri-membranous ventricular septal defect (VSD), resulting in a left to right ventriculoatrial shunt. We present a case of a patient with restenosis of a prior bioprosthetic aortic valve (AV) who underwent reoperative AV replacement (AVR), which was complicated by a unique iatrogenic Gerbode defect with concurrent LV-LA communication. Our case highlights the unique complications resulting from ventriculoatrial shunts, with consideration paid to the management of ventriculoatrial defects described.
Hemophilia C is a rare bleeding disorder characterized by a deficiency in clotting factor XI (fXI) and has no standard of care for preoperative optimization before cardiac surgery. Normalization of fXI levels in patients with hemophilia C can be achieved with fresh frozen plasma (FFP), which sometimes results in allergic reactions. We present a case of a patient with hemophilia C requiring coronary artery bypass grafting surgery who developed an allergic reaction to FFP. Our report underscores the balance between thrombosis and bleeding risks when devising a perioperative plan for patients with hemophilia C.
Cardiovascular complications of hypereosinophilic syndrome (HES) constitute a significant source of morbidity and mortality, with heart involvement found in approximately 40%–80% of patients. In patients with right heart failure due to an intracardiac mass, induction of general anesthesia poses numerous challenges. The effects of positive pressure ventilation on right ventricular (RV) physiology can quickly lead to precipitous cardiovascular collapse, which increases the importance of maintaining adequate negative pressure ventilation strategies. Current strategies involve awake femoro-femoral cannulation with partial vs full flow femoro-femoral cardiopulmonary bypass (CPB), but both methods increase the risk of intraoperative blood loss due to systemic heparinization prior to sternotomy. In this case report, the authors describe an approach to anesthetizing a patient with severe right ventricular heart failure due to an intracardiac mass due to idiopathic HES. This approach involves femoral cannulation prior to induction of general anesthesia, airway topicalization, inhalational induction with fiberoptic intubation, and sternotomy with aortic/bicaval cannulation before paralysis.
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