scholarly journals Anaesthesia management of a difficult airway patient with severe aortic stenosis for major oncosurgery

2021 ◽  
Vol 8 (4) ◽  
pp. 597-599
Author(s):  
Ninad Chodankar ◽  
Disha Kapadia ◽  
Hemant Mehta
Keyword(s):  
Aortic Stenosis ◽  
Difficult Airway ◽  
Severe Aortic Stenosis ◽  
Mouth Opening ◽  
Perioperative Period ◽  
Fiberoptic Intubation ◽  
Team Approach ◽  
Free Fibula Flap ◽  
Early Recovery ◽  
Perioperative Morbidity

Over the past few decades, oncosurgical procedures are increasing in number, require considerable expertise and training for anaesthetising such patients. Aortic Stenosis itself poses great challenge, causes significant increase in morbidity and mortality in the perioperative period. Head, neck oncosurgical procedures with difficult airway requiring awake fiberoptic intubation in such patients adds to the challenge.We describe once such case of previously operated Carcinoma of oral cavity with new growth involving mandible for excision of tumour with neck dissection and mandibular reconstruction with a free Fibula flap. This patient now presented with anticipated difficult airway with restricted mouth opening and a recent diagnosis of severe Aortic stenosis with mean gradient across aortic valve of 52mmHg and valve area 0.8 cm2.Such patient requires multidisciplinary team approach by cardiologist, anaesthesiologist, surgeon and intensivist to prevent perioperative morbidity and facilitate early recovery.

scholarly journals Nasal intubation with bronchial blocker in a patient with difficult airway for thoracoscopic surgery

2021 ◽  
Vol 9 (2) ◽  
pp. 629
Author(s):  
Deepak C. Koli ◽  
Aditi P. Kadakia ◽  
Prajakta D. Latkar ◽  
Hemant H. Mehta
Keyword(s):  
Case Report ◽  
Difficult Airway ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Left Lung ◽  
Mouth Opening ◽  
Lower Lobe ◽  
Bronchial Blocker ◽  
Fiberoptic Intubation ◽  
Open Approach

We describe a case report of a 49 years old male, a case of Carcinoma tongue with one finger mouth opening operated multiple times, currently presented with pleural based soft tissue lesion in lower lobe of left lung with query metastasis posted for video assisted thoracoscopy surgery (VATS) SOS open thoracotomy and wedge resection of the lesion. Considering difficult airway due to restricted mouth opening we opted for an awake nasal fiberoptic intubation followed by general anaesthesia. One lung ventilation was achieved with CoopdechTM bronchial blocker type A with standard cuff size in left main stem bronchus. Postoperative course of patient was uneventful. In this case report we highlight the importance of use of fiberoptic bronchoscope and bronchial blocker for lung deflation in the management of difficult airway in VATS, as incomplete deflation of the nondependent lung during VATS can lead to poor surgical exposure and inadequate space for surgical manipulation which in turn can compromise the success of the procedure, and may possibly lead to conversion into an open approach.

The Ross-Konno Procedure as Reoperative Treatment in a Young Adult with Congenital Aortic Stenosis

2012 ◽  
Vol 15 (4) ◽  
pp. 182
Author(s):  
Fotios A. Mitropoulos ◽  
Meletios A. Kanakis ◽  
Sotiria C. Apostolopoulou ◽  
Spyridon Rammos ◽  
Constantine E. Anagnostopoulos
Keyword(s):  
Young Adult ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Young Patients ◽  
Uneventful Recovery ◽  
Ross Procedure ◽  
Congenital Aortic Stenosis ◽  
Biological Prostheses

<p>Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients.</p><p>We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.</p>

A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant

2014 ◽  
Vol 17 (1) ◽  
pp. 25 ◽  
Author(s):  
Lei Gao ◽  
Qin Wu ◽  
Xinhua Xu ◽  
Tianli Zhao ◽  
Wancun Jin ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Severe Aortic Stenosis ◽  
Ascending Aorta ◽  
Balloon Aortic Valvuloplasty ◽  
Congenital Aortic Stenosis ◽  
Novel Approach ◽  
Low Weight ◽  
Aortic Valvuloplasty ◽  
Peak Gradient

<p><b>Background:</b> Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.</p><p><b>Methods:</b> The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.</p><p><b>Results:</b> The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.</p><p><b>Conclusions:</b> In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.</p>

New Trends and Developments in Patients with Severe Aortic Stenosis – Towards Optimal Treatment?

2009 ◽  
Vol 5 (2) ◽  
pp. 81 ◽  
Author(s):  
Martijn WA van Geldorp ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers ◽  
A Pieter Kappetein ◽  
◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Treatment Modalities ◽  
Diagnostic Tools ◽  
Number Of Patients ◽  
Transcatheter Valve

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.

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