Annals of Cardiac Anaesthesia最新文献

{"title":"An Unusual Cause of Common Chamber to LA Anastomosis Obstruction in Supracardiac TAPVC.","authors":"Richa Soni, Kalla Krishna Prasad Gourav, Loganathan Chakravarthy, Veerappa Vishwanath, Rajarajan Ganesan","doi":"10.4103/aca.aca_116_25","DOIUrl":"10.4103/aca.aca_116_25","url":null,"abstract":"<p><strong>Abstract: </strong>This report details a rare cause of early postoperative pulmonary venous obstruction following supracardiac total anomalous pulmonary venous connection repair in a 4-week-old infant. Despite a successful sutureless anastomosis, intraoperative transesophageal echocardiography revealed significant flow acceleration (1.69 m/s and a mean gradient of 5 mm Hg). Surgical inspection identified that the left atrial appendage (LAA) was sagging over the common chamber-to-left atrial anastomosis, causing an obstruction. The mechanical obstruction was relieved by suturing the LAA to the undersurface of the left pleural cavity, which prevented further sagging onto the anastomosis.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"261-264"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670215","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":"Awake Off-pump Coronary Artery Bypass Grafting with Thoracic Segmental Spinal Anesthesia: Initial Experience in Three Patients.","authors":"Nezir Yılmaz, Cengiz Güven, Abuzer Deniz Sürücü","doi":"10.4103/aca.aca_251_25","DOIUrl":"10.4103/aca.aca_251_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"290-293"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670165","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":"Impact of Saline Instillation and Drainage on Oxygenation During Whole Lung Lavage.","authors":"Dhananj Shivganesh, Krishna Prasad Gourav, Ritesh Agarwal, Sunder Negi, Bhupesh Kumar","doi":"10.4103/aca.aca_262_25","DOIUrl":"10.4103/aca.aca_262_25","url":null,"abstract":"<p><strong>Abstract: </strong>Whole lung lavage (WLL) for pulmonary alveolar proteinosis, performed under one-lung ventilation (OLV), illustrates the dynamic interplay between alveolar expansion and pulmonary vascular responses. Instillation of warm saline into the nonventilated lung compresses pulmonary vessels, mimicking hypoxic pulmonary vasoconstriction and enhancing oxygenation. Conversely, drainage of the saline relieves vascular compression, worsens ventilation-perfusion (V/Q) mismatch, and leads to a decline in oxygenation. This cyclical pattern underscores the physiological shifts that influence oxygenation during WLL.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"294-296"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669588","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":"Perioperative Management of a Patient with Good Syndrome and Pancytopenia Undergoing Sternotomy and Thymectomy.","authors":"David Jarrold, Mohamed Shajas Shahabudin, Anil Darbar, Karishma Chandarana, Apostolos Nakas","doi":"10.4103/aca.aca_199_25","DOIUrl":"10.4103/aca.aca_199_25","url":null,"abstract":"<p><strong>Abstract: </strong>Good Syndrome is a rare form of immunodeficiency occurring in conjunction with thymoma. It is known to be associated with haematological manifestations, primarily pure red cell aplasia but more rarely aplastic anaemia and thrombocytopenia. We report a 61-year-old man with type AB thymoma, Good syndrome and severe pancytopenia undergoing sternotomy and thymectomy. Due to its rarity and often delayed presentation or diagnosis, case reports detailing peri-operative management are limited. This case highlights the complexity of perioperative management in Good syndrome and we detail the patient's management from initial diagnosis through major surgery and postoperative care.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"285-289"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669857","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":"Predicted vs. Actual Endotracheal Tube Size in Pediatric Cardiac Surgery for Children with Down Syndrome.","authors":"Madan M Maddali, Haitham K Al-Abri, Is'haq Al Aamri, Panchatcharam M Sathiya","doi":"10.4103/aca.aca_280_25","DOIUrl":"10.4103/aca.aca_280_25","url":null,"abstract":"<p><strong>Background: </strong>Children with Down syndrome have a higher risk of upper airway obstruction and smaller tracheal lumens due to conditions like subglottic stenosis and laryngomalacia. While the Cole formula is widely used to predict endotracheal tube (ETT) size in non-syndromic children, this formula may be inappropriate for children with Down syndrome undergoing cardiac surgery.</p><p><strong>Objectives: </strong>The primary objective was to determine whether the actual endotracheal tube size used in children with Down syndrome undergoing cardiac surgery matches the size predicted by the Cole formula. The secondary objectives included age-stratified comparisons (<1 year vs. ≥1 year) of predicted versus actual endotracheal tube size used, along with the impact of airway characteristics, drug usage, and postoperative outcomes on the actual endotracheal tube used.</p><p><strong>Settings and design: </strong>A retrospective cohort study at a single tertiary pediatric cardiac center.</p><p><strong>Measurements and main results: </strong>A total of 182 pediatric patients with Down syndrome who had cardiac surgery were enrolled. Data were collected from patients with Down syndrome who had cardiac surgery with tracheal intubation using uncuffed ETTs. Patients were divided into two groups: those under one year of age and those one year or older.</p><p><strong>Results: </strong>The actual ETT size used was statistically different from the size predicted by the Cole formula across all patients (P < 0.001). The difference between the actual and predicted ETT sizes remained significant in both age groups and did not decrease with age [both groups: P <0.001]. For the entire cohort, the actual ETT size was smaller than predicted by the standard Cole formula, with a correlation coefficient of 0.797. Infants with Down syndrome under one year of age were more likely to be on anti-failure medications (64.2% vs. 43.9%, P = 0.011) and have more complex cardiac anomalies (RACHS-1 score) compared to older children. These conditions had not impact on the endotracheal tube size used. The incidence of reintubation was 11.9% in the younger group and 7.0% in the older group, with respiratory causes being the most common reason.</p><p><strong>Conclusions: </strong>The Cole formula consistently overestimated the required ETT size for children with Down syndrome undergoing cardiac surgery. While Cole's formula can serve as a general guide, in children with Down syndrome, individual anatomical variations necessitate clinical judgment and adjustments. This highlights the need for improved methods to predict ETT size in this population.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"219-227"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669814","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":"Thoracic Outlet Syndrome due to Intramuscular Hematoma Following Removal of Central Venous Catheter.","authors":"Muhilan Senthilkumar, Ms Saravana Babu, Arem Jyothi, Anoop Ayyappan","doi":"10.4103/aca.aca_234_25","DOIUrl":"10.4103/aca.aca_234_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"301-302"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670104","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":"Sub-glottic Diameter Measured by Ultrasonography Predicts Outer Diameter of the Clinically Best Fit Endotracheal Tube in Infants Undergoing Pediatric Cardiac Surgery.","authors":"Jessin P Jayasankar, L Sai Sudha, Praveen Kumar Neema","doi":"10.4103/aca.aca_189_25","DOIUrl":"10.4103/aca.aca_189_25","url":null,"abstract":"<p><strong>Background: </strong>Tracheal intubation with an oversized endotracheal tube (ETT) in a pediatric patient can lead to serious complications following extubation, including stridor, hoarseness, difficulty in breathing, increased work of breathing, respiratory failure, cardiac failure, and reintubation. Whereas undersized ETT may lead to erratic delivery of preset tidal volume during mechanical ventilation and increase the risk of aspiration of gastric contents. This study investigates the correlation between ultrasound measured subglottic airway diameter and ETT size selected by the anesthesiologists in infants undergoing cardiac surgery.</p><p><strong>Materials and methods: </strong>We measured the subglottic airway diameter in sniffing position with a 25 mm linear high frequency hockey stick transducer using ultrasonography machine and compared it to the ETT size selected by the anesthesiologist. We analyzed the agreement between the two methods.</p><p><strong>Results: </strong>One hundred and three infants undergoing cardiac surgery were included. The median age of the infants were 30 days (interquartile range 19-90 days). The anesthesiologist's ETT size choice matched ultrasonography (USG)-measured subglottic diameter in all patients, with 90 receiving 3.5 mm ID and 13 receiving 4.0 mm ID ETTs. Upsizing of the ETT due to air leak was not required in any patient. A significant correlation was found between USG-measured ETT size and the anesthesiologist's choice of clinically best-fit ETT.</p><p><strong>Conclusions: </strong>Subglottic diameter measured by USG reliably predict outer diameter of the ETT size in infants undergoing cardiac surgery. The finding is particularly valuable in low-volume centers where anesthesiologists may have limited experience with pediatric cardiac surgery.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"186-190"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669965","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":"A Case of Central Airway Obstruction.","authors":"Don J Palamattam, Tony J Joseph, Tinku Joseph, Praveen K Neema","doi":"10.4103/aca.aca_203_25","DOIUrl":"10.4103/aca.aca_203_25","url":null,"abstract":"","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"298-299"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670201","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":"Evaluation of Perioperative Anesthetic Outcomes in Patients with Williams Syndrome Based on the Risk Stratification.","authors":"Sai Charan Kopparapu, Udit Khajuria, Saravana Babu, Subin Sukesan, Shrinivas V Gadhinglajkar, Prasanta Kumar Dash","doi":"10.4103/aca.aca_212_25","DOIUrl":"10.4103/aca.aca_212_25","url":null,"abstract":"<p><strong>Introduction: </strong>Williams syndrome (WS) is associated with morbidity and mortality during surgical and nonsurgical procedures. The primary objective of the study was to assess the incidence of perioperative mortality in patients with WS among the risk groups. The secondary objectives were to analyze the mortality cause and study the various perioperative outcomes among the WS risk groups.</p><p><strong>Materials and methods: </strong>In this retrospective observational study, we included patients with WS who underwent anesthesia for elective corrective surgical repair and nonoperative procedures like radiological imaging and cardiac catheterization procedures in our institute from January 2009 to April 2024. The patients were stratified into high-, medium-, and low-risk groups based on the risk factors recorded from the hospital medical records. We analyzed the incidence of perioperative mortality and associated outcomes among the three risk groups of patients with WS.</p><p><strong>Results: </strong>Medical records of 30 patients with WS were studied. The incidence of mortality in the high-risk group was 11.8%, whereas there was no mortality in the other risk groups. The mortality occurred in high-risk group patients who underwent sedation with inhalational anesthesia for a radiological imaging procedure. There was no significant difference in the duration of mechanical ventilation, vasoactive inotropic score, or length of intensive care unit and hospital stay among the three risk groups.</p><p><strong>Conclusion: </strong>Mortalities were observed in the high-risk group who underwent sedation with inhalational anesthesia for radiological imaging. Preoperative risk stratification is needed to identify the risk category and alleviate the major perioperative cardiac events in patients with WS.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"247-252"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669634","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":"Ebstein's Enigma: Managing Unforeseen Interventricular Septal Hematoma After One and Half Ventricular Repair for Ebstein's Anomaly.","authors":"S Keerthy Nath, Shrinivas V Gadhinglajkar, M S Saravana Babu, Mamatha Munaf, Baiju S Dharan","doi":"10.4103/aca.aca_194_25","DOIUrl":"10.4103/aca.aca_194_25","url":null,"abstract":"<p><strong>Abstract: </strong>Interventricular septal hematoma (IVSH) is an extremely rare complication reported after the congenital heart surgery. An IVSH is defined as a hemorrhagic dissection between muscle bundles of the interventricular septum. Herein, we discuss a case of IVSH, which developed following one and half ventricular repair for Ebstein's anomaly in a 47-year-old lady. It appeared initially as an intraventricular mass on postoperative echocardiography creating a diagnostic dilemma. It was confirmed to be an IVSH on intraoperative transesophageal echocardiography during surgical re-exploration indicated for increasing size of the lesion. The IVSH was not drained due to the possible risk of development of an iatrogenic ventricular septal defect and decided to be treated conservatively. It was followed up on the postoperative serial echocardiography. Frequent echocardiographic monitoring during the perioperative period is essential to detect this rare complication. The IVSH should be distinguished from an RV thrombus as the management strategy differs between them. The IVSH may be managed conservatively in a hemodynamically stable patient, whereas the RV thrombus requires immediate thrombolysis or surgical intervention. We also deliberate on the role of perioperative echocardiography in the diagnosis and decision making.</p>","PeriodicalId":7997,"journal":{"name":"Annals of Cardiac Anaesthesia","volume":"29 2","pages":"265-269"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13179097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669236","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}