Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition which includes abnormal development of left sided cardiac structures leading to inadequate systemic perfusion following postnatal closure of the patent ductus arteriosus (PDA). Surgical palliation may be accomplished through a 3 staged process -Norwood procedure. This surgery is usually done within the first two weeks of your child's life -Bidirectional Glenn procedure. This procedure is generally the second surgery. It's done when your child is between 3 and 6 months of age. -Fontan procedure. This surgery is usually done when your child is between 18 months and 4 years of age. Patients with HLHS may need to undergo other non-cardiac surgical procedures during the first years of life posing a real challenge to the anesthesiologist, surgeon and the entire medical team. We present the case of a 18-months old, 9 kg infant who presented for cryptorchidism surgery. Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia. The intraoperative implications of the hybrid anatomy are discussed, options for anesthetic care presented, and previous reports of anesthetic care for such patients reviewed. Conclusion: LMA combined with local anesthesia was effective to maintaining optimal cardiac function of this child patient with HLHS In summary, children with palliated HLHS have anesthetic considerations that must be followed in order to reduce perioperative morbidity and mortality in this high-risk pathology.

Background: Myasthenia gravis is an autoimmune neuromuscular disorder that causes the destruction and overall decrease in functional acetylcholine receptors at the neuromuscular junction. The resultant respiratory and cardiovascular implications are a primary cause of mortality; therefore, a complete and comprehensive understandings of this disorder is vital for the anesthesia provider. Anesthesia management in myasthenia gravis is a great challenge for all anesthesiologists. In this disease, even small doses of muscle relaxants could lead to delayed recovery for respiratory muscles. Case report: We present the case of a 38 years old woman (weight 87 kg) diagnosed with Myasthenia Gravis, which symptoms has worsened recently. The case demonstrates the anesthetic challenges involved, with a focus on the overall approach, pharmacologic considerations, physiological changes, and an emphasis on preoperative operative and post-operative optimization. Conclusion: Thymectomy is a common procedure performed in cases of myasthenia gravis (MG) with a thymoma or general MG that does not improve with medical therapy. During anesthesia the use of propofol or sevoflurane with opioids without the use of any neuromuscular blocking agents has been used with success.

This paper reports the clinical characteristics, diagnosis, and treatment of myself after being infected with Covid-19. After comprehensive treatment including nasal cannula oxygen therapy, antiviral and anti-infection therapies, liquid volume management, glucocorticoids, analgesia and sedation, blood tests control, anticoagulation, and thrombus prevention, and electrolyte balance maintenance, after 24 days finally my health situation was good. The purpose of this case report is to provide a reference for the clinical diagnosis and treatment of myself, in-home condition in this critical situation.

Introduction; The diagnosis of COVID-19 is quite challenging due to the inconsistent correlation between laboratory findings, radiological imaging, and the clinical picture and contact history of the patient. The patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) face double risk because CBP triggers an intense inflammatory response and the leading cause of mortality in COVID-19 patients is “cytokine storm”. In our institution 15 confirmed cases operated on with open-heart surgery. 9 cases isolated CABG, 4 cases valvular combined with CABG, and 1 valvular disease. Materials and method; All patients undergoing elective or urgent cardiac surgery at “Mother Theresa” ’s Hospital from 11 March to 30 November 2020 were included in this study. Patients diagnosed with COVID-19 infection via positive throat swab taken due to clinical suspicion postoperatively were reviewed. Patients characteristics, type of intervention, date of COVID-19 diagnosis. Results: 9 patients (72%) normal recovery, no respiratory failure, only 3-5 days of fever (max 39,4). 3 of them a moderate respiratory failure. 3 patients with severe respiratory failure. Only 3 deaths (26,6%). Recommendation: It's important to a preoperative screening for COVID-19 patients. The outcome of cardiac surgical patients who contracted COVID-19 infection perioperatively is extremely poor. Aggressive respiratory assistance (early intubation), high doses of corticosteroids, and anticoagulation, better results.

Background; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms. Case presentation; A 48-year-old patient 72 kg, height 172 cm with dilated cardiomyopathy, his course was complicated by pump failure requiring LVAD HeartMate III placement 3 years (Milan Italy). The parameters of the LVAD pump were determined for the patient from the moment of the Pump speed 5300 rpm Flow 4.4 lpm was set. The patient performed moderate activity under normal conditions. The patient regularly took Coumadin to keep the recommended INR levels at the recommended target values ​​2.5. At the site of the exit of the cavity from the skin in the region of the right hypochondrium, there was an infection that for a long time was treated with various schemes with ambulatory antibiotics Conclusions; In the present case we showed that successful eradication of a chronic LVAD driveline infection was only possible when approached both surgically and conservatively. It is important to note that a good knowledge of the physiopathology of heart failure, the widest possible information on the treatment of heart failure with the help of LVAD implantation is very important in the treatment and survival of these patients.