Cardiac surgery in a patient with idiopathic aplastic anemia: a case report

Transcatheter aortic valve implantation in a patient with aplastic anemia

Aplastic anemia is a syndrome involving pancytopenia caused by bone marrow insufficiency. Pancytopenia increases the surgical risk of bleeding and infection. Here, we report a successful transcatheter aortic valve implantation (TAVI) in a patient with aplastic anemia. The patient was a 76-year-old woman who was admitted to our hospital with syncope. Laboratory testing showed pancytopenia, and echocardiography revealed severe aortic valve stenosis. Although the log.EuroSCORE and STS Score were not overly high, because of the presence of pancytopenia, surgical aortic valve replacement was considered too high risk, making her a candidate for TAVI. In this case, the patient's pancytopenia was so severe that even TAVI without preparation was considered high risk. In light of this, we carried out a two-day preoperative administration of granulocyte colony-stimulating factor and transfused packed red blood cells and platelet concentrates. TAVI was performed via the left femoral artery using the cut-down procedure under general anesthesia. The postoperative course was uneventful, and she was discharged on the sixth postoperative day. With adequate preoperative preparation, TAVI may be performed safely in high-risk patients with hematologic disorders. <Learning objective: Transcatheter aortic valve implantation (TAVI) is widely performed for aortic stenosis patients at high surgical risk. Although patients with severe pancytopenia can be candidates for TAVI, severe pancytopenia may increase the surgical risk even for TAVI. To reduce the risk, adequate preparations before the procedure are required. Here, we report the preoperative preparation before TAVI that lowered the surgical risk in a patient with severe pancytopenia.>.

A triple challenge: thrombocytopenia in a 7-year-old girl with unrepaired d-transposition of the great arteries, ventricular septal defect, and pulmonary hypertension

Thrombocytopenia can be a real challenge during cardiac surgery in children with cyanotic congenital heart disease. This report describes a 7-year-old girl with d-transposition of the great arteries, ventricular septal defect, pulmonary hypertension, chronic thrombocytopenia, polycythemia, and chronic renal impairment. The thrombocytopenia improved several days after splenectomy. The child then underwent a successful arterial switch operation with ventricular septal defect closure.

Child with aplastic anemia: Anesthetic management

Aplastic anemia is a rare heterogeneous disorder of hematopoietic stem cells causing pancytopenia and marrow hypoplasia with the depletion of all types of blood cells. This results in anemia, neutropenia and thrombocytopenia, which pose a challenge to both surgical and anesthetic management of such cases. We report a child with aplastic anemia who sustained traumatic ulcer on the arm and underwent split-thickness skin grafting under general anesthesia. There are only two case reports on anesthetic considerations in aplastic anemia patients in the literature. The anesthetic management is challenging because of the rarity of the disease, associated pancytopenia and immunosuppression.

Necrotizing fasciitis caused by Serratia marcescens after venous access port implantation in a child with acute lymphoblastic leukemia

Necrotizing fasciitis is a potentially life-threatening infection of deep skin layers and subcutaneous tissues that can easily spread across the fascia plate and is usually the result of a combined infection with anaerobic and aerobic microorganisms. The patient typically complains of excruciating pain, which is not necessarily in accordance with clinical signs. Early recognition of the condition is very important, and aggressive treatment with a combination of antibiotics and surgical procedure is crucial. We present a case of a 15-year-old girl with acute lymphoblastic leukemia who developed necrotizing fasciitis after venous access port implantation during induction chemotherapy.