We report about a patient with congenitally corrected transposition of the great arteries and ebsteinoid malformation of left atrioventricular (AV) valve who presented with incessant orthodromic atrioventricular reciprocating tachycardia due to a left posteroseptal accessory pathway. Radiofrequency catheter ablation using trans-septal approach successfully eliminated the posteroseptal pathway across the morphologic tricuspid valve. This report highlights the importance of delineating the anatomy of the interatrial septum in complex congenital heart diseases for performing safe trans-septal puncture during ablation of accessory pathways.
Surgeons are required to keep themselves updated on ever-increasing list of drugs that may influence the outcomes of surgeries, especially in an emergency scenario. Here, we report a case of acute abdomen, wherein the patient was on dabigatran, a 'Non-vit. K/Direct Oral Anti-Coagulant' (NOAC/DOAC). NOACs are relatively recent additions to anticoagulation care. In our patient, dabigatran was prescribed by a cardiologist to prevent the occurrence of stroke in the patient who was suffering from atrial fibrillation. In case of uncontrolled bleeding, or when an emergency surgery is needed, the effect of dabigatran can be reversed with the use of a specific monoclonal antibody -idarucizumab. Knowledge about the drug & its reversal agent, and a multi-disciplinary approach, could make it possible for us to operate on the patient, and avoid excessive bleeding during the surgery.
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