Myasthenia gravis is a chronic autoimmune disease affecting voluntary skeletal muscles. The altered sensitivity of acetylcholine receptors to muscle relaxants and concomitant treatment with anticholinesterase in these patients affect their anaesthetic management. Patients who have undergone bowel anastomosis and are on regular anticholinesterase treatment are susceptible to anastomotic leaks. We report successful anaesthetic management of class I myasthenic patient with coexisting small bowel intussusception operated for jejuno-ileal anastomoses using regional, inhalational and intravenous (i.v) anaesthesia based on train of four responses, and avoiding the use of reversal (anticholinesterase).

Infective endocarditis is a rare occurrence in the main pulmonary artery trunk and even rarer in tetralogy of Fallot.

Evaluation of the atria and interatrial septum • Determine types: Ostium secundum defect [Video 1]/ostium primum defect/ sinus venosus atrial septal defect (ASD)/ coronary sinus (CS) type ASD • Determine ‐ size, shape, number, and location of any atrial/ventricular communication present; and the direction of shunt flow [Figure 1] • Rule out ‐ partial anomalous pulmonary venous connection, left superior vena cava (LSVC) • Transesophageal echocardiography (TEE) views: Mid‐esophageal aortic valve short axis (ME AoV SAX) view, ME modified bicaval view/ME bicaval view [Figure 2].

ventricular (LV) hypertrophy. The chest X‑ray except for cardiomegaly with LV apex was inconclusive. Upon TTE, patient was diagnosed with RSOVA draining into the left ventricle. Cardiac catheterization and angiography further showed‑normal coronaries, right coronary cusp (RCC) aneurysm with rupture into left ventricle causing severe regurgitation [Figure 1], normal left ventricle function, absence of any ventricular septal defect (VSD), no gradient across left ventricle and aorta and Qp/Qs = 1. Patient was scheduled for RSOVA repair with aortic valve repair/replacement.Following anesthetic induction, intraoperative multiplane, color Doppler, two‑dimensional and three‑dimensional (3D) ‑ TEE examination was performed (iE33

Cystic echinococcosis (hydatid disease) arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS) solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope.

Patients with myasthenia gravis (MG) developing coronary artery disease following irradiation of thymoma have been reported previously. Incidental preoperative diagnosis of thymoma has also been reported during cardiac surgery in the past. This case report intends to sensitize clinicians to the challenges of a redo mediastinal surgery in a post-coronary artery bypass grafting (CABG) patient with symptomatic MG and thymoma and to discuss the pros and cons of a simultaneous thymectomy in a patient undergoing cardiac surgery.