Anomalous coronary artery (ACA) is common in tetralogy of Fallot (TOF), which influences not only surgical decision-making but also impacts perioperative management, especially when it is crossing the right ventricular outflow tract (RVOT). Optimum preoperative investigations like echocardiography and angiography decide the best practice in a patient with TOF and ACA. Perioperative transesophageal echocardiographic (TEE) assessment and intraoperative surgical findings may alter the surgical technique. TEE confirms the presence of ACA, guides surgical decision-making, and detects the lurking dangers. Among ACA, dual left anterior descending artery (dLAD) has the least incidence while it remains potentially life-threatening during intracardiac repair of congenital heart diseases (CHDs). The authors present a case of TOF with dLAD and exert the role of TEE in the perioperative management of CHDs.

Background: Valve-in-valve transcatheter heart valve (ViV THV) differs from native transcatheter heart valve (THV) in preprocedural assessment, procedure and anticipated complications during procedure. Transesophageal echocardiography (TEE) plays a supplemental role to guide cardiologist during procedure and helps in monitoring complications. Methods: In this case report, we describe the TEE findings observed during a valve-in-valve transcatheter aortic valve replacement (ViV TAVR) procedure. The findings helped to guide the procedure, supplemented detecting a rare complication of malformed THV and thereby improved patient outcome. Conclusion: TEE can prevent complications, detect abnormalities early, and improve patient outcome, when taken in conjunction with other imaging modalities.

Coronary arteriovenous fistula (CAVF) is a rare form of congenital heart disease. Among the CAVFs, the right coronary artery (RCA) fistula is common. The majority of patients remain asymptomatic, and CAVFs are detected incidentally. Coronary angiography remains the primary diagnostic and therapeutic modality in the assessment of the fistula. In the perioperative setting, transesophageal echocardiography (TEE) is the modality of choice, which has been rarely reported to date. It not only confirms the fistulous tract but also confirms the other associated anomalies, biventricular function, and the adequacy of surgical repair. We report a TEE imaging of CAVF between the left circumflex artery (LCx) and right-sided superior vena cava (SVC).

The classic clinical signs of tamponade often do not occur in the postcardiac surgical patient. Here, we present a case of postcardiac surgery tamponade presenting with atypical clinical signs and diagnosed with transesophageal echocardiography (ECG).

Cardiac rhabdomyoma is the most common benign pediatric cardiac tumor.¹ Frequently, they are associated with tuberous sclerosis, an autosomal disorder resulting in hamartomatous lesions inside the brain, heart, lungs, and kidneys. Bidirectional Glenn (BDG) shunt is a type of palliative procedure done in infants and the pediatric age group, which drains blood from the superior vena cava (SVC) into the pulmonary circulation, especially in univentricular physiology,² to improve oxygenation. Here, we present an interesting case of an acyanotic pediatric patient presenting with a right ventricular (RV) tumor, in which the BDG was performed to offload the RV, which was not reported previously in the literature. Written consent for the publication of this case was obtained from the patient's relatives. Also, the authors were directly involved in the perioperative care of the patient.

The sinus of valsalva is a small outpouching in the root of the aorta supporting the coronary arteries and the aortic leaflets. Sinus of valsalva aneurysm (SOVA) is an abnormal dilatation of the aortic root located between the aortic valve (AV) annulus and the sinotubular junction. Being a rare condition, it can be fatal if left untreated. It usually has an intracardiac course, but it sometimes protrudes into pericardial space and ruptures into right or rarely left heart chambers to form an aorta-cardiac fistula. The patient usually develops the gradual onset of dyspnea, and rhythm disturbances, if ruptured, can present as acute heart failure.