Annals of Cardiac Anaesthesia最新文献

{"title":"Stent-Related Infective Endocarditis Revealing Aortic Cusp Perforation on Intraoperative TEE: A Case Report Altering Surgical Strategy.","authors":"Rajesh Madavathazathil Gopalakrishnan, Dheeraj Arora, Akhil Diwan","doi":"10.4103/aca.aca_268_25","DOIUrl":"10.4103/aca.aca_268_25","url":null,"abstract":"<p><strong>Abstract: </strong>Coronary stent infective endocarditis (IE) is a rare but serious complication of percutaneous coronary intervention. Extension to adjacent valvular structures, particularly causing cusp perforation of the aortic valve, is exceedingly uncommon. Intraoperative transesophageal echocardiography (TEE) may reveal complications not detected preoperatively, thereby changing surgical plans. We report a patient who underwent coronary angioplasty followed by persistent fever and suspicion of stent infection. Angiography detected stent related left anterior descending artery aneurysm and preoperative plan for stent explantation and revascularization was made. However, on the operating table, intraoperative TEE demonstrated perforation of the right coronary cusp of the aortic valve with severe aortic regurgitation. Surgical strategy was modified to include stent explantation, coronary artery bypass graft (CABG), and aortic valve replacement. The stent specimen showed evidence of infection. The patient's postoperative course was favorable under targeted antibiotic therapy. This case illustrates how intraoperative TEE can uncover unanticipated valvular destruction in stent-related IE and meaningfully alter surgical decision-making. Early recognition, imaging vigilance, and flexibility in surgical planning are essential in management of such rare but high-risk complications.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"424-426"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Ventricular Pacing Induced Severe Mitral Regurgitation in Atrioventricular Block.","authors":"Richa Soni, Sunder L Negi, Tsering Sangdup, Bhupesh Kumar, K P Gourav, Ira Dhawan, Nishit Santoki","doi":"10.4103/aca.aca_189_23","DOIUrl":"10.4103/aca.aca_189_23","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"442-444"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advantage of Transesophageal Echocardiography Over Transthoracic Echocardiography as an Incidental Finding of Atheroma in the Descending Aorta Changed the Surgical Plan.","authors":"Mamatha Munaf, I Vignesh, Jupi Talukdar, Shrinivas V Gadhinglajkar","doi":"10.4103/aca.aca_315_25","DOIUrl":"10.4103/aca.aca_315_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"446-448"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Preincisional Ultrasound Guided Pecto-intercostal Fascial Plane Block with Ropivacaine and Fentanyl in Patients Undergoing Open Heart Surgery by Median Sternotomy - A Prospective Single Blinded Randomized Controlled Study.","authors":"Indira Malik, Geeta Ahlawat, Deepika Budhwar, Sandeep Singh, Manasmita Dalai, Vineet Kumar, Disha Gupta, Naveen Malhotra","doi":"10.4103/aca.aca_269_25","DOIUrl":"10.4103/aca.aca_269_25","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the role of ultrasound (USG) guided Superficial Parasternal intercostal plane block (SPIP)/Pecto-Intercostal Fascial Plane Block (PIFB) on post sternotomy pain and postoperative outcomes in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>This prospective single-blinded, randomized controlled study was conducted in 75 adult patients of age 18-75 years of ASA II-III undergoing cardiac surgery by median sternotomy. Patients were randomized into three groups with 25 patients in each group. Group I patients did not receive any block. Group II patients received USG guided PIFB with 0.4% ropivacaine+ 25 μg fentanyl on each side. Group III patients received USG guided PIFB with 0.4% ropivacaine+ 50 μg fentanyl. Numeric rating scale (NRS) for pain, Time to extubation, hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure) and SpO 2 at various time points (T0: at extubation, T1: 2 h, T2: 4 h, T3: 8 h, T4: 16 h, T5: 24 h, T6: 48 h post extubation), cumulative fentanyl consumption and rescue analgesia, post operative nausea vomiting (PONV), time to drain removal, catheter removal, ambulation, length of intensive care unit (ICU), and hospital stay were noted.</p><p><strong>Results: </strong>Group II and III patients as compared to group I showed lower NRS values, shorter time to extubation, drain and catheter removal, early ambulation, stable hemodynamics, less fentanyl consumption and rescue analgesia requirement, less incidence of PONV, early ICU and hospital discharge. Group II and III had comparable results with no significant difference.</p><p><strong>Conclusion: </strong>USG guided SPIP/PIFB provides improved postoperative pain control, reduces the need for perioperative opioids, faster extubation, early ICU and hospital discharge.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":"335-344"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Technical Error: Strengthening Causal, Detection, and Management Frameworks for Guidewire Loss During Central Venous Catheterization.","authors":"Jay Prakash, Shio Priye, Rishabh Kumar","doi":"10.4103/aca.aca_380_25","DOIUrl":"10.4103/aca.aca_380_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"458-459"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Albumin Concentration and Timing on Acute Kidney Injury After Adult Cardiac Surgery: A Systematic Review and Meta-analysis.","authors":"Toru Abo, Takumi Umibe, Kenji Nakano, Yoshiyasu Tongu, Kensei Oya","doi":"10.4103/aca.aca_345_25","DOIUrl":"10.4103/aca.aca_345_25","url":null,"abstract":"<p><strong>Abstract: </strong>The effect of hyperoncotic (20%-25%) human albumin on cardiac-surgery-associated acute kidney injury (CS-AKI) is uncertain. This study evaluated whether intraoperative or postoperative administration of 20%-25% albumin influences the risk of CS-AKI compared with crystalloids or iso-oncotic (4%-5%) albumin. Systematic review and meta-analysis of randomized controlled trials (RCTs) and risk-adjusted cohort studies were conducted. Risk ratios (RRs) were pooled using random-effects models. Literature search of PubMed, Embase (Ovid), and Cochrane CENTRAL was carried out from January 1, 1995, to July 17, 2025. Adults undergoing on-pump CS. Four eligible studies-two RCTs and two cohort studies, encompassing 6651 patients-were included. About 20%-25% of human albumin was administered either intraoperatively or within 24 h postoperatively. Comparators were crystalloids or 4%-5% albumin. The primary outcome was the incidence of any-stage AKI within 7 days of surgery. Pooled analysis showed 20%-25% albumin increased the risk of CS-AKI (RR 1.10, 95% confidence interval [CI] 1.05-1.16; I² =0%). Restriction to RCTs yielded a similar result (RR 1.12, 95% CI 1.04-1.20). The increased risk was consistent for both intraoperative (RR 1.09) and postoperative (RR 1.12) administration, but the interaction between infusion timing was non-significant ( P = 0.59). Infusion of 20%-25% albumin is associated with a modest but consistent increase in postoperative AKI, independent of infusion timing from intraoperative to postoperative within 24 h. Until adequately powered trials resolve the remaining imprecision, routine perioperative administration of hyperoncotic albumin should be approached with caution.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":"325-334"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombocytopenia After Cardiac Surgery: A Single-Center Retrospective Study.","authors":"David Haszon, Sahar Abdallah, Qingyan Jia, Thibaut Lutz, Stéphane Santiago, Marius Tifrea, Lucie Chastaingt, Jérome Jouan, David Vandroux","doi":"10.4103/aca.aca_367_25","DOIUrl":"10.4103/aca.aca_367_25","url":null,"abstract":"<p><strong>Background: </strong>Postoperative thrombocytopenia is a frequent complication in cardiac surgery, associated with increased morbidity and mortality. Our study aimed to describe platelet count after cardiac surgery and identify predictors of postoperative thrombocytopenia.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center study including 519 adult patients who underwent cardiac surgery without operative platelet transfusion. The primary outcome was the incidence of postoperative thrombocytopenia, defined using three thresholds: <150 G/L, <100 G/L, and <50 G/L. Platelet counts were recorded daily from preoperative day to postoperative day 7. Independent predictors were identified using multivariate logistic regression for a threshold of 100 G/L.</p><p><strong>Results: </strong>Thrombocytopenia < 150 G/L occurred in 306 patients (59%), <100 G/L in 92 (18%), and < 50 G/L in 35 (7%). The incidence of thrombocytopenia depended on the type of surgery ( P < 0.0001). Mitral valve surgery, ascending aorta procedures, and the use of sutureless aortic valve prostheses were associated with increased thrombocytopenia rates. Platelet counts were higher in patients who have had off-pump coronary surgery within the first five days ( P < 0.0001). Five independent predictors were identified: older age ( P = 0.022), lower baseline platelet count ( P < 0.0001), higher creatinine ( P = 0.04), operative transfused units of red blood cells ( P = 0.015), and higher autotransfusion volume ( P = 0.02). The model using only preoperative variables achieved an AUC of 0.83. Finally, thrombocytopenia <100 G/L was associated with more blood loss ( P = 0.001), more postoperative transfusions ( P < 0.0001), and longer intensive care unit stay ( P = 0.001).</p><p><strong>Conclusion: </strong>Our study differentiates pre- and perioperative risk factors for thrombocytopenia in cardiac surgery to define a targeted, individualized platelet management strategy.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":" ","pages":"345-351"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morquio Syndrome for Aortic Valve Replacement: Anesthesia Concerns - A Case Report.","authors":"Jupi Talukdar, Surekha Vondutla, Mamatha Munaf, K P Unnikrishnan, Varghese T Panicker","doi":"10.4103/aca.aca_249_25","DOIUrl":"10.4103/aca.aca_249_25","url":null,"abstract":"<p><strong>Abstract: </strong>Morquio syndrome is a lysosomal storage disease that can lead to glycosaminoglycan deposition in the tissues. Skeletal deformities, cardiovascular complications, and airway abnormalities are well-recognized in this condition, specifically owing to thickened mucosa and epiglottis, making fiberoptic-guided intubation less successful. Our patient had severe aortic regurgitation and was posted for aortic valve replacement. Anesthetic challenges encountered during the management of the case, and a different approach to airway management are highlighted in this report. With increased survival of patients affected with Morquio syndrome, cardiac anesthesiologists might see an increasing number of similar patients requiring corrective cardiac surgery.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 3","pages":"417-420"},"PeriodicalIF":1.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Analgesic Efficacy of Intrathecal Morphine and Ultrasound-Guided Bilateral Erector Spinae Plane Block in Patients Undergoing Open Heart Surgery with Midline Sternotomy: An Open Label Randomized Control Trial.","authors":"Visalatchi Karuppiah, Rakesh Kumar, Sadik Mohammed, Anita Chouan, Manoj Kamal, Swati Chhabra, Alok Sharma","doi":"10.4103/aca.aca_302_25","DOIUrl":"10.4103/aca.aca_302_25","url":null,"abstract":"<p><strong>Background and aims: </strong>Intrathecal morphine (ITM) and erector spinae plane block (ESPB) decrease postoperative pain in standard cardiac surgery. In this study, we compared the analgesic efficacy of ITM and B/L ESPB in patients undergoing open heart surgeries.</p><p><strong>Methods: </strong>After approval from the institutional ethics committee and written informed consent from patients scheduled for open heart surgeries, they were randomized into two groups: Group ITM patients received ITM (5 mcg/kg), whereas Group ESPB patients received bilateral ESP block (0.3 mL/kg of 0.5% ropivacaine on either side). The primary outcome was to compare postoperative fentanyl consumption during the first 24 hours of ICU stay after extubation. Secondary outcomes were postoperative VAS at rest and on cough during the first 24 hours, pre- and postoperative pulmonary function, and number of rescue analgesics. Quantitative variables were presented as mean (SD) or median (IQR). Categorical variables were expressed as numbers or percentages. Spirometry variables were compared over time between the groups using Friedman test.</p><p><strong>Results: </strong>The ITM group had significantly less median fentanyl consumption compared to the ESPB group during the first 24 hours postoperative period [0 (0-75) μg vs. 234 (160-336) μg (95% CI, 171.65, 255.38); P < 0.001]. The VAS score at rest and during cough was significantly better in the ITM group. FEV1 and FVC reduced postoperatively in both groups with significantly better values in the ITM group.</p><p><strong>Conclusion: </strong>ITM administered prior to induction provides superior postoperative analgesia compared to bilateral ESPB in patients undergoing open-heart surgery. It significantly reduces opioid requirements, improves patient satisfaction, and enhances postoperative pulmonary function.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"212-218"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombus Formation During Pulmonary Vein Ablation: When Routine Turns Risky.","authors":"Álvaro Barranco de Santiago, Mireia Pozo-Albiol, Samira Martínez-Otero, Jean-Baptiste Guichard, María José Carretero, Marc Giménez-Milà","doi":"10.4103/aca.aca_245_25","DOIUrl":"10.4103/aca.aca_245_25","url":null,"abstract":"<p><strong>Abstract: </strong>Atrial fibrillation (AF) is the most common sustained arrhythmia and a major contributor to thromboembolic events. Pulmonary vein isolation is the main therapy to achieve rhythm control, and intraoperative transesophageal echocardiography (iTEE) enhances procedural safety by guiding transseptal puncture and detecting possible complications such as thrombi formation. Nevertheless, intraprocedural catheter thrombosis remains remarkably infrequent and is poorly documented in medical literature. A 59-year-old man with paroxysmal AF and a prior transient ischemic attack, under anticoagulation with apixaban, presented for redo pulmonary vein ablation. Due to premature interruption of anticoagulation, iTEE revealed a large thrombus attached to the ablation catheter after transseptal puncture, so the procedure was postponed and the patient recovered without complications. A second ablation under uninterrupted anticoagulation was performed 4 weeks later, with successful isolation of all pulmonary veins and restoration of stable sinus rhythm. Intraprocedural catheter thrombosis is a rare but potentially life-threatening complication not currently addressed in AF management guidelines. This case underscores the pivotal role of iTEE in the early detection of this unexpected event, supporting its use for both procedural guidance and surveillance of thromboembolic complications. Effective anticoagulation management, favoring uninterrupted anticoagulant use, remains essential to mitigate thromboembolic risk. Overall, this report highlights the importance of integrating advanced imaging and strict anticoagulation protocols to prevent catheter-related thrombotic events during AF ablation.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"281-284"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}