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Incidental finding of interrupted inferior venacava during minimally invasive cardiac surgery.

ABSTRACT: We report a case of 44-year-old female patient with congenital heart disease, ostium secundum atrial septal defect (ASD) with moderate mitral regurgitation for minimally invasive ASD repair along with mitral valve repair. Venous cannulations were performed through right internal jugular vein and right femoral vein (RFV) and arterial cannulation was accomplished through right femoral artery. Intraoperative transesophageal echocardiography (TEE) could not visualize venous cannula through RFV. However, cardiopulmonary bypass (CPB) was initiated and surgery was proceeded. During surgery, patients abdomen became tense and distened, ontable ultrasound examination of abdomen was done after completion of the surgery to rule out hemoperitoneum but was inconclusive, patient was evaluated further under fluoroscopy in cathlab and found to have interrupted inferior vena cava. Postoperative course of the patient was uneventful. We discuss the importance of preoperative evaluation and the role of TEE in placement of cannulas during minimally invasive cardiac surgery.

SUBMITTER: Singh SS

PROVIDER: S-EPMC8253027 | biostudies-literature |

REPOSITORIES: biostudies-literature

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A case report of an interrupted inferior vena cava and azygos continuation: implications for preoperative screening in minimally invasive cardiac surgery.

Project description:BackgroundFemoral cannulation is commonly used in minimally invasive cardiac surgery to establish extracorporeal circulation. We present a case with a finding that should be evaluated when screening candidates for minimally invasive cardiac surgery.Case summaryA 57-year-old male patient was scheduled for minimally invasive repair of the mitral and tricuspid valve and a MAZE procedure. During surgery there was difficulty advancing the venous cannula inserted in the right femoral vein. On transoesophageal echocardiography a guidewire advanced from the femoral vein was observed entering the right atrium from the superior vena cava. Despite inserting a second venous cannula in the jugular vein, venous drainage was insufficient for minimal invasive surgery. The approach was converted to a median sternotomy with bicaval cannulation. Re-examination of the preoperative computed tomography (CT) scan showed an interrupted inferior vena cava (IVC) with azygos continuation.DiscussionIn patients with major venous malformations such as the interrupted IVC with azygos continuation a full sternotomy is the preferred approach. The venous system should be evaluated when screening candidates for minimally invasive mitral valve surgery with preoperative CT. Additional cues to suspect interruption of the IVC are polysplenia and a broad superior mediastinal projection on the chest radiograph, mimicking a right paratracheal mass.

| S-EPMC8422328 | biostudies-literature

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Anesthesia for minimally invasive cardiac surgery.

Project description:Due to its potential benefits and increased patient satisfaction minimal invasive cardiac surgery (MICS) is rapidly gaining in popularity. These procedures are not without challenges and require careful planning, pre-operative patient assessment and excellent intraoperative communication. Assessment of patient suitability for MICS by a multi-disciplinary team during pre-operative workup is desirable. MICS requires additional skills that many might not consider to be part of the standard cardiac anesthetic toolkit. Anesthetists involved in MICS need not only be highly skilled in performing transesophageal echocardiography (TEE) but need to be proficient in multimodal analgesia, including locoregional or neuroaxial techniques. MICS procedures tend to cause more postoperative pain than standard median sternotomies do, and patients need analgesic management more in keeping with thoracic operations. Ultrasound guided peripheral regional anesthesia techniques like serratus anterior block can offer an advantage over neuroaxial techniques in patients on anti-platelet therapy or anticoagulation with low molecular weight or unfractionated heparin The article reviews the salient points pertaining to pre-operative assessment and suitability, intraoperative process and postoperative management of minimally invasive cardiac procedures in the operating theatre as well as the catheterization lab. Special emphasis is given to anesthetic management and analgesia techniques.

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Minimally invasive strabismus surgery (MISS) for inferior obliquus recession.

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Project description: Not available

| S-EPMC8024829 | biostudies-literature

Iatrogenic right coronary artery occlusion during minimally invasive cardiac surgery-tricuspid annuloplasty-a case report.

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| S-EPMC9537403 | biostudies-literature

Concomitant intra-atrial excision of the left atrial appendage during robotic-assisted minimally invasive cardiac surgery.

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| S-EPMC10017964 | biostudies-literature

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Project description: Not available

| S-EPMC7339795 | biostudies-literature

Left Atrial Dissection During Minimally Invasive Mitral Valve Surgery

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| S-EPMC10442375 | biostudies-literature

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| S-EPMC6158874 | biostudies-literature

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