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The incidence aortic valve injury during percutaneous coronary intervention is scarce, mostly resulting in acute aortic regurgitation. However, rarely patients may remain asymptomatic in the immediate post-procedure period and present latter with chronic aortic regurgitation. Determining etiology of such an aortic regurgitation may be challenging. We present a case of a 51-year-old man with history of percutaneous coronary intervention for coronary artery disease and moderate aortic regurgitation scheduled for coronary artery bypass grafting and aortic valve replacement. Intra-operative transesophageal echocardiography was instrumental in deciding etiology of aortic regurgitation that change surgical management of the patient.In the patients with stenotic upper respiratory airways tumor, the tracheal intubation during the surgical resection is sometimes impossible. In these situations, Extracorporeal Membrane Oxygenation appears to be an interesting temporarily alternative to ventilation to allow tumor removal. In this report the authors describe a case of successful resection of tracheal tumor in an 80-year-old female patient in which tracheal intubation was impossible. A circulatory assistance was used to perform the operation. Afterwards, tracheal intubation was easily performed for the rest of the operation.Massive pulmonary hemorrhage during pulmonary thromboendarterectomy (PTE) can be managed by a conservative approach with mechanical ventilatory support, positive end-expiratory pressure, lung isolation, reversal of heparin, and correct of coagulopathy. We present three challenging cases that developed intrapulmonary hemorrhage during/after PTE and managed successfully. The first patient had bleeding from the bronchial artery and right internal mammary collaterals, which was managed by coil-embolization. The second patient had a breach in the blood airway barrier in the right upper lobar segment of the lung, and the repair was done using a surgical absorbable hemostat. The third patient developed reperfusion injury, he was instituted on veno-venous extracorporeal membranous oxygenation, a week later, the patient recovered completely. An algorithm was adopted and modified to our requirements; all the 3 challenging intrapulmonary hemorrhage cases were successfully managed. This algorithm can be used for satisfactory outcomes in patients who suffer intrapulmonary hemorrhage during PTE.The anesthetic management of patients with a mediastinal mass represent a challenge due to the potential for difficult ventilation and intubation, as well as the risk of cardiovascular collapse upon induction of general anesthesia. Different strategies and alternatives have been described. We present the case of a 70-year-old man with a right para-tracheal mass extending into the anterior mediastinum with 90% mid-tracheal lumen obstruction who was successfully managed with venous-venous extra-corporeal membrane oxygenation (ECMO) during mass debulking and tracheal stent placement.Central venous access is useful for monitoring central venous pressure, inserting pulmonary artery catheter and administering vasoactive drugs in hemodynamically unstable patients. Central venous catheter (CVC) insertion through internal jugular vein may cause major vessel injury, inadvertent arterial catheterization, brachial plexus injury, phrenic nerve injury, pneumothorax, and haemothorax. We describe unusual presentation of hemothorax following CVC placement in a patient undergoing vestibular schwannoma excision. The patients’ trachea intubated after several attempts during which thiopentone up to 600 mg administered. Thereafter, under ultrasound guidance, an 18G introducer needle placed in the right internal jugular vein but guide-wire did not advance. Meanwhile, the patient became hemodynamically unstable and a CVC placed in right subclavian vein and norepinephrine infused at 0.05 μg/kg/min; simultaneously, 1000 ml normal saline administered through CVC. The hemodynamic instability attributed to thiopentone administered during endotracheal intubation. The surgical procedure cancelled, and the patient shifted to critical care unit (CCU). Mechanical ventilation continued. In CCU, hemodynamic parameters further deteriorated and 0.1 μg/kg/min epinephrine started. Bedside lung ultrasound showed a large collection in pleural space on the right side. Chest radiograph showed a homogenous opacity obliterating costophrenic angle on the right side. A possibility of hemothorax considered, chest tube inserted and 1000 ml sanguineous fluid drained. Blood sample drawn through CVC showed air from proximal and middle lumen but distal lumen drained blood. Another CVC placed in the femoral vein and subclavian vein CVC removed. The vasoactive drug infusion transferred to CVC in femoral vein and 2 units pRBCs transfused. Hemodynamic parameters gradually stabilized and the patient recovered completely.Primary intestinal lymphangiectasia (PIL) is a rare disorder characterized by dilated intestinal lacteals that result in leakage of excessive serum proteins and lymphocytes into the gastrointestinal (GI) tract culminating in protein-losing enteropathy. The GI loss of protein and possible antithrombin III (AT-III) loss creates a prothrombotic environment. The surgical management of congenital heart disease (CHD) in presence of PIL can present with altered heparin response and can impose problems in instituting cardiopulmonary bypass (CPB). We report a case of surgical closure of ventricular septal defect with PIL with altered heparin response. selleck chemicals llc Such an association of PIL with altered heparin response in CHD has not been reported in literature.Once regarded as a rare complication, the potentially fatal bone cement implantation syndrome (BCIS) has been increasingly reported. BCIS can present as transient desaturation, hypotension, cardiac dysrhythmias, and cardiovascular collapse. Diagnosis of BCIS is often clinical and confirmed with computed tomography (CT) imaging postoperatively. However, point of care ultrasound (POCUS) examination could be a helpful and timely tool to clinch the diagnosis in a sudden cardiovascular collapse. We present a case of Grade 3 BCIS where POCUS examination revealed a massive clot in the right atrium, which supports the diagnosis.