Perioperative implications of Coronary-cameral fistula.

Coronary-cameral fistulas (CCFs) are mostly congenital in origin and rarely acquired. Clinical symptoms are decided by the hemodynamic significance of the coronary fistula. Even in asymptomatic patients, it is essential to know about coronary CCF particularly if the patient is to undergo cardiac surgery with cardioplegic cardiac arrest.

Ipsilateral foot drop after aortobifemoral bypass.

Peripheral nerves can be injured by a direct result of the anesthetic technique of regional anesthesia or it can be contributed/compounded by poor perioperative positioning and padding, tourniquets, and the nature of surgery and diseases affecting the microvasculature of nerves. We present a case of perioperative peripheral nerve injuries which could not be explained by anesthesia technique nor surgery per se.

Sudden appearance of new clot.

A patient having mitral stenosis with chronic atrial fibrillation, large left atrium, and spontaneous echo contrast is expected to have clot in LA or LAA. TEE is more sensitive to detect thrombus in LA and LAA than transthoracic echocardiography. However, false-negative results can still occur due to multilobed LAA, and a thrombus can be potentially missed.

Aortic regurgitation after chemoport catheter insertion: Diagnostic dilemma.

Catheter insertion in central vein can potentially cause accidental arterial injury. However it is very unusual to see such catheter in aorta causing aortic regurgitation. Pressure monitoring and Ultrasound guidance can reliably prevent accidental arterial puncture.

Guillain-Barré syndrome after cardiac surgery: diagnostic dilemma.

Guillain-Barré Syndrome after cardiac surgery is very uncommon. Mechanism remains elusive although immunological reaction post surgery has been postulated. This disease can potentially increase the morbidity of the postoperative patients and generally cannot be explained by the cardiac disease or interventions.

A curious case of raised gradient across mitral bioprosthetic valve.

High Doppler valve gradient is generally suggestive of valve thrombosis. However, it should be corroborated with the finding of restricted leaflet movement to confirm the diagnosis. In the present case, abnormally high gradient was not associated with limited leaflet movements or any valve thrombus.