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Pleiotropic effects of Vitamin D (Vit D) on various cell types and causative association in the epidemiology of cardiovascular diseases is known for ages. Observational studies have successfully linked Vit D deficient states to critical illness and increased ICU morbidity and mortality. The role of preoperative Vit D deficiency on postoperative outcome in cardiac surgery patients is a new horizon for research. A prospective observational cohort study was planned to assess impact of pre-operative Vit D deficiency on post-operative cardiac outcomes in adult patients undergoing cardiac surgery, Vit D level was assessed in the preoperative period and divided into group I Vit D deficient (20ng/ml). Primary outcome was to study the occurrence of myocardial infarction, arrhythmia, low cardiac output syndrome (LCOS) and inotropic requirement. Secondary outcomes were duration of mechanical ventilation, ICU length of stay, hospital stay and mortality. Vit D deficiency was associated with increased incidence of arrhythmia (p=0.019), LCOS (0.003) and high inotropic requirements (p=0.001) with no relation to occurrence of MI (p=0.422) and mechanical support (p= 0.114) as compared to the sufficient group. Vit D deficiency was also associated with increased duration of mechanical ventilation (p=0.008), ICU (p=0.001) and hospital stay (p=0.00) as compared to other group. Vitamin D deficiency was associated with increased occurrence of arrhythmia, LCOS and high inotropic requirements. ICU morbidity in the form of increased duration of mechanical ventilation, ICU and hospital stay was increased in patients with Vit D deficiency.

Background Vitamin D deficiency is a very common occurrence in cardiac patients. It has been proved that cardiac surgery and cardiopulmonary bypass accelerate the deficiency further. The postoperative outcomes of patients deteriorate in the presence of vitamin D deficiency. Perioperative supplementation of vitamin D is the only solution to the problem. Hence, the present systematic review was conducted to derive the efficacy and safety of vitamin D supplementation on postoperative outcomes in cardiac surgery patients. Method Publications over duration of last 10 years was searched from different database and web sites. The data from full-text research articles were analyzed for the effect on different postoperative outcomes and side effects. Result Eight randomized control trials were retrieved on the effect of perioperative vitamin D supplementation in cardiac surgery patients and their postoperative outcomes. Six articles (75%) were found to be in favor of improvement in postoperative outcome. Two articles (25%) did not find any difference of outcome between the control and treatment group. All the studies observed the restoration of vitamin D to normal and no adverse effects from supplementation. Conclusion Perioperative vitamin D supplementation improves the postoperative outcomes after cardiac surgery. It is effective and safe to supplement vitamin D in cardiac surgery patients.

There is a need for a sensitive, safe, and cost-effective tool for coronary assessment among asymptomatic post-operative children who have undergone arterial switch operation (ASO) for transposition of great arteries (TGA). Adenosine stress echocardiography may be useful in assessing major structures as well for coronary functional assessment. Twenty-six children [median age 6.0 years; IQR 4.9–7.1 years, (22 boys)], who had undergone ASO at a median age of 40 days (IQR 30–75 days), were prospectively included. Left ventricular ejection fraction (LVEF) was calculated in both rest and stress studies (140 µg/kg/min of adenosine IV over 4 min), along with assessment of regional myocardial wall motion. Coronary flow reserve (CFR) was also measured in the left anterior descending artery (LAD). Technetium 99m-MIBI [0.2mCi/kg] was injected after 2 min of adenosine infusion. Adenosine infusion had to be stopped in two children, due to transient atrioventricular (AV) block. The LVEF increased from 55.87 ± 7.27 to 61.20 ± 7.70% (p < 0.001) with adenosine stress. No significant regional wall motion abnormality was seen in rest or stress. Distal LAD could not be visualized in four patients. Basal and peak coronary flow velocities were 41.51 ± 14.12 and 74.18 ± 6.01 cm/s. Mean CFR was 1.91 ± 0.51. Myocardial perfusion scintigraphy (MPS) was normal in all the patients. Four patients were lost to follow-up and remaining children did not develop any adverse events in the follow-up period of 64.5 ± 7.19 months. Adenosine stress echocardiography is feasible as the initial screening test in the assessment of asymptomatic post-operative children with ASO, at minimal to no inconvenience to the patient. The findings concurred with stress MPS.

Extracorporeal membrane oxygenation (ECMO) has emerged as a mechanical circulatory support system with rapid advancements in its technology. It has become an essential tool in the care of adults and children with severe cardiac and pulmonary dysfunction refractory to conventional therapy. The ease of implementation and cost effectiveness makes it highly desirable alternative for bridge to recovery or decision especially in developing countries like India. However complications and challenges related to ECMO, require more rigorously designed studies towards redefining management of patients. Anaesthesiologist being the perioperative physician has an impotant role in managing patients with ECMO. This review focuses on fundamental principles, technology, indications, management, weaning, transport protocols, complications, future directions as well as Indian scenario with ECMO utilization. Keywords: Extracorporeal membrane oxygenation, ECPR, Indian overview, Integrated ECMO, Perioperative clinical practices Venoarterial ECMO, Venovenous ECMO.

Background Fenestration of the baffle/conduit is believed to reduce pleural effusion following the Fontan operation. However, equivocal results have been observed with or without fenestration. This study aims to evaluate the efficacy of fenestration on the amount and duration of pleural effusion following the Fontan operation. Methods About 40 patients undergoing extracardiac Fontan (ECF) were randomized into two groups: one with fenestration (ECF-F; n = 20) or without fenestration (ECF-NF; n = 20). Primary outcome was the amount and duration of pleural effusions. Secondary outcomes were time to removal of the chest tubes, hospital stay, and readmission to the hospital because of recurrent pleural within 30 days of the operation. Results Mean age was 11.5 ± 5.07 (range, 8.7-13.5) years in the ECF-F group and 13.6 ± 0.4 years (range, 10.5-15.5) in the (ECF-NF) group. The total drain output was 7.89 mL/kg/d in ECF-NF compared with 6.9 mL/kg/d in the ECF-group (P = .14). Time for removal of pleural tubes was 14.6 ± 0.95 days in the ECF-NF group compared with 11.6 ± days in the ECF-F group. Total duration of hospital stay was higher but not significant in the ECF-NF group compared with the ECF-F group. Two patients in ECF-NF required readmission to the hospital within 30 days following discharge, while there were no readmissions in the ECF-F group. Conclusion Contrary to the literature, the creation of a fenestration in the ECF circuit was not clearly associated with a reduction in the amount and duration of pleural effusion compared with a non-fenestrated Fontan. These findings may be debatable in high risks versus low risk candidates. However in the present study, in a low risk canditates undergoing the Fontan operation, the daily amount of pleural drainage was no different. Larger studies are needed to confirm these findings.

To compare the changes in thoracic fluid content, PaOProspective observational study.Tertiary-care cardiac center.Over an 18-month period, from December 2019 to May 2021, 111 patients who underwent CAB grafting were enrolled. Group I constituted OPCAB patients and Group II the ONCAB patients.After induction, the authors measured thoracic fluid content (TFC), pulmonary compliance, airway pressures, and the PaOAt TThe change in TFC was greater in the ONCAB group, despite the fact that the fluid balance was higher in the OPCAB group. A higher TFC in ONCAB led to lower PaO

Ankle block represents a regional anesthesia technique to provide anesthesia for the procedures related to the foot. It is mainly used as a sole anesthesia technique or as an adjunct for postoperative pain relief in foot operations. It is an infiltrative block with advantages like being technically easier, safe, having minimal side effects, and having a high success rate. Management of postoperative pain is an essential service provided by a cardiac anesthesiologist to patients undergoing operative procedures, but the knowledge in providing regional anesthesia may be used beyond the operating room or critical care unit. In the present case, we administered an ankle block to alleviate the pain in case of dry gangrene.

Presence of malignant pheochromocytoma tumor and coronary artery disease is extremely rare and carry high perioperative risk. The postoperative morbidity and mortality are increased by many folds. In the reference case, adrenal tumor had infiltrated to inferior vena cava (IVC), liver and right kidney. He had associated coronary artery disease. We describe the management of a patient with malignant tumor of adrenal gland undergoing surgical removal with all arrangements for coronary artery bypass grafting and intrathoracic extraction of tumor from IVC. It is a rare example of cardiac patient for non-cardiac surgery. Keywords: Cardiac patient for non-cardiac surgery, Coronary artery disease, Malignant pheochromocytoma, Pheochromocytoma.

Introduction: Mifepristone, also known as RU 486 is used to cause medical abortion during the early part of pregnancy. It is used up to 10 weeks of pregnancy. Mifepristone blocks the secretion of progesterone. Misoprostol is an analogue of prostaglandin that increases uterine contraction and cervical dilation. The combination of both is used in studies with variable efficacy for medical abortion. Objective: To find out the efficacy of mifepristone and misoprostol combination by systematic review of studies from different parts of the world. Materials and Methods: Literature search in internet was conducted with the topic of efficacy of mifepristone and misoprostol combination on early trimester medical termination of pregnancy. Sixteen articles were finalized after applying the review criteria. Four large trials on the efficacy of mifepristone and misoprostol conducted in USA and Australia and 12 studies from different parts of the world were included. Most of the studies are randomised control trials and descriptive type. Results: It was found that the efficacy of mifepristone and misoprostol varied from 70.93% to 100% with a mean of 92.19%. The time interval between intake of mifepristone and misoprostol, and complete abortion varied from 10 hrs to 24 hrs. Conclusion: Systematic review detected the mean efficacy of mifepristone and misoprostol combination to be 92.19%. Keywords: Early trimester termination of pregnancy, Efficacy, Mifepristone, Misoprostol, Systematic review.

Background : Pulmonary vascular resistance, an important determinant of shunting across ventricular septal defects (VSD), rises at both extremes of lung volume. Aims : We sought to determine the effect of changes in tidal volumes (VT) on pulmonary blood flow (Qp), systemic blood flow (Qs), and shunt (Qp/Qs) in children with VSD. Setting : Single-center teaching hospital. Design : Prospective observational study. Methods : Thirty children with a mean age of 11.8 ± 5 months undergoing surgical closure of VSD were studied. Hemodynamics and shunt-related parameters were assessed using transthoracic echocardiography measured at three different VT i.e. 10, 8, and 6-ml/kg keeping the minute ventilation constant. Results : Reduction in VT from 10 to 8 to 6 ml/kg led to a reduction in gradient across VSD measuring 23.5, 20 and 13 mmHg respectively (P < 0.001). Similarly, right ventricluar outflow tract (RVOT) diameter, RVOT velocity time integral, Qp (57.3 ± 18.1, 50.6 ± 16.9, 39.9 ± 14.7 mL; P < 0.001), Qs (24.1 ± 10.4, 20.0 ± 8.7, 15.3 ± 6.9 mL; P < 0.001) and peak airway pressure (17.2 ± 1.5, 15.8 ± 1.3, 14.5 ± 1.2 cmHg; P < 0.001) showed progressive decline with decreasing VT from 10 to 8 to 6 ml/kg, respectively. However, Qp/Qs (2.4 ± 0.4, 2.6 ± 0.4, 2.6 ± 0.4) demonstrated a minor increasing trend. Conclusion : Lower VT reduces the gradient across VSD, the pulmonary blood flow, and the peak airway pressure. Hence, ventilation with lower VT and higher respiratory rate maintaining adequate minute ventilation might be preferable in children with VSD. Further studies are required to confirm the findings of this pilot study.

Introduction: Craniosynostosis (CS) syndrome is an autosomal dominant condition (ADC) classically combining with CS and nonsyndromic CS (NSCS) including digital anomalies of the hands and feet. The majority of cases caused by a heterozygous mutation (HM) in the third immunoglobulin-like domain (IgIII) of fibroblast growth factor receptor (FGFR) 2 mutations outside this region of the protein. Material and Methods: We tried to find out the spectrum of genes involved in CS syndrome caused by the heterozygous missense mutation, the IgII and IgIII of FGFR2. FGFR3, FGFR4, TWIST, and MSX genes were performed and verified through the Indian population with CS children. Results: We find out that at conserved linker region (LR), the changes occurred among the larger families. Independent genetic origins, but phenotypic similarities add to the evidence supporting the theory of selfish spermatogonial selective advantage for this rare gain-of-function FGFR2 mutation. Polygenic novel mutation in both syndromic and nonsyndromic cases of CS promotes the translational research and holds a great promise to reproduce the molecular-based therapy and treatment as well. In this article, we summarized that genes involved in CS as evidence-based approach for characterization, identification, gene expression, and tissue engineering. We also described other related genes and proteins for the CS involvement and improvement of the diseases progression. Conclusion: HM again repeated the old story for both groups of syndromic CS and NSCS of Asian Indian children. Here, for the first time, we clearly reported that IgIII of FGFR2 mutations outside this region of the protein and tyrosine kinase (TK1 and TK2) responsible for both in molecular and cellular level for CS. It adds an evidence for future molecular targeting therapy to repair CS.

A 2-year-old child was diagnosed with subaortic ventricular septal defect (VSD) with severe infundibular and valvular pulmonary stenosis (PS) by transthoracic echocardiography. Intraoperative transesophageal echocardiography (TEE) detected aneurysmal interventricular and interatrial septum (IAS), subaortic VSD, and right ventricular outflow tract (RVOT) with an additional midmuscular VSD. The aneurysmal interventricular septum (IVS) was repaired. An accessory tricuspid papillary muscle was attached to RVOT, which was augmented with a transannular pericardial patch to have minimal postoperative gradient without sacrificing the accessory papillary muscle (APM). This rare case poses a challenge to the anesthetist and surgeon in the form of diagnostic differences, severe right ventricle (RV) dysfunction with aneurysmal IVS, and difficulty in reconstruction of RVOT. Intraoperative TEE played a greater role to diagnose the IVS aneurysm, additional VSD and guide for appropriate surgery. How to cite this article Das S, Kumar A. Intraoperative Echocardiographic Detection of Septal Aneurysm and Additional Ventricular Septal Defect in a Child with Tetralogy of Fallot. J Perioper Echocardiogr 2017;5(1):21-24.

Introduction: Heart Transplant in India started in 1994. We were initially doing 1-2 per year but the numbers have picked up since 2014 and we have done 25 in the past 3 years. We describe our experience of the last 4 years in this paper. Results: Initially, we experienced a relatively higher rate of rejections, fungal infections and graft failure. As we changed protocols, stopped using induction therapy except in high risk, maintained higher levels of immune suppression and tapered steroids faster in the first year, the complications reduced. All patients who had rejections and all the later transplants were maintained on a regime of tacrolimus, mycophenolate mofetil and steroids along with six months of valgancyclovir, voriconazole and co-trimoxazole. Steroids were tapered by six months to 0.1 mg/kg per day in all patients. Conclusions: In our recent patients, infection was the most common adverse event followed by rejection and PGD. In the latter half of our experience, we found that the complications reduced, suggesting that experience leads to less complications.

Double aortic arch (DAA) is a rare disease requiring high index of clinical suspicion for diagnosis. If undiagnosed, it can pose a serious challenge during anesthetic induction because of dynamic nature of tracheal compression. When DAA is associated with other congenital heart diseases, anesthetic management becomes even more challenging. We report the perioperative anesthetic management of a very rare case of DAA associated with pentalogy of Fallot.

Context: Frequent incidence of early postoperative memory impairment (POMI) after cardiac surgery remains a concern because of associated morbidity, impaired quality of life, and increased health care cost. Aim: To assess the effect of preoperative statin therapy on POMI in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Setting and Design: Prospective observational study in a tertiary level hospital. Methods: Sixty patients aged 45-65 years undergoing OPCAB surgery were allocated into two groups of 30 each. Group A patients were receiving statin and Group B patients were not receiving statins. All patients underwent memory function assessment preoperatively after admission to hospital and on the 6 th postoperative day using postgraduate institute memory scale. Statistical Analysis: Appropriate tests were applied with SPSS 20 to compare both groups. The value P < 0.05 was considered statistically significant. Multiple regression analysis was performed with confounding factors to determine the effect on memory impairment. Results: Patients in Group A showed significant postoperative deterioration in 6 of the 10 functions and in Group B showed deterioration in 9 of 10 functions tested compared to preoperative scores. Intergroup comparison detected less POMI in Group A compared to Group B and was statistically significant in 8 memory functions. Multiple regression analysis detected statin as an independent factor in preventing memory impairment. Conclusions: Preoperative statin therapy attenuates the early POMI in patients undergoing OPCAB. Future long-term studies will define the efficacy of statin on POMI.

Background: Craniosynostosis (CS) conditions are included with the premature fusion of one or more multiple cranial sutures. As the second leading and most common craniofacial anomaly and orofacial clefts globally. Syndromic and nonsyndromic CS (NSCS) occur as a part of a genetic syndrome unlike Apert, Crouzon, Pfeiffer, Muenke, and Saethre–Chotzen syndromes. Approximately, 90% of the cases of CS arises from NSCS group and it is now a great challenge for the researcher and neurosurgeon for Indian-origin children, a great burden worldwide. Material and Methods: Study design: Prospective study of analysis sequence pattern on CS and NSCS from January 2007 to 2018 was carried out. Inclusion criteria: Diagnosed cases in syndromic and NSCS patients between 3 months and 14 years of age either preoperative or postoperative were included in the study of both groups (syndromic and NSCS). Exclusion criteria: Patients with primary microcephaly (secondary CS), postural plagiocephaly, incomplete data, no visual perception, and who were lost to follow-up, and who had no interest to participate the study were excluded from the study. Bioinformatic analysis: We have performed systematic bioinformatic analysis for all responsible genes by combining with using through the GeneDecks, Gene Runner, DAVID, and STRING databases. Genes testing: FGF family genes, MSX genes, such as Irf6, TP63, Dlx2, Dlx5, Pax3, Pax9, Bmp4, Tgf-beta2, and Tgf-beta3 were found to be involved in Cleft lip and cleft palate (CL/P), and Fgfr2, Fgfr1, Fgfr3, and TWIST, MSX, MSX1, 2 were found to be involved in both the groups of CS (SCS + NSCS). Results: FGFR, MSX, Irf6, TP63, Dlx2, Dlx5, Pax3, Pax9, Bmp4, Tgf-beta2, and Tgf-beta3 demonstrated and find out that in CL/P, and Fgfr2, Fgfr1, Fgfr3, and Twist1 had accurate sequence data with more than accuracy of 95% reported with proper order with additional anomalies CS through newly developed tools. Conclusion: Newly developed techniques of GeneDecks, Gene Runner, DAVID, and STRING databases gave better picture to analyze the larger population, patients (SCS + NSCS) with complex genetic, maternal, parental age, environmental, and stochastic factors contributing to NSCS networking, signaling, and pathways involvement. This bioinformatic tools analyzed better prediction of CS and NSCS sequences guiding us the newer invention modalities of pattern of screening and further development of recent future application.

PURPOSE: Neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker of acute kidney injury (AKI). Goal-directed therapy (GDT) in on-pump coronary artery bypass grafting (CABG) has been associated with lower post-operative NGAL levels in recent studies. The present study aimed at comparing plasma (P) and urinary (U)-NGAL levels following the use of GDT versus conventional haemodynamic therapy (CT) in patients undergoing on-pump CABG. METHODS: A prospective randomised controlled study conducted in a single university hospital. A total of 54 patients in the GDT group and 56 patients in CT group after exclusions. RESULTS: U-NGAL was significantly lower immediately post-surgery (T(1)) in GDT group (25.11 ± 1.5 versus 27.80 ± 1.7 μg/L; p

To know the effects of psychological preparation on perioperative stress, anxiety, and mood in children undergoing cardiac surgery and their parents.Prospective randomized control nonblinded trial.Single-center tertiary teaching hospital.A total of 60 children aged 5 to 15 years undergoing cardiac surgery were included in the study. One of the parents, preferably the father, was selected from the respective children.Subjects were randomized into 2 groups: noninterventional (group 1) and interventional (group 2). Intervention was in the form of toys and video games in children, and counseling and information in parents. Preoperative and postoperative anxiety in parents was measured using the State-Trait Anxiety Inventory (STAI), stress using the Index of Clinical Stress (ICS) scale by Abell, and the Ottawa mood scale. In children, the STAI-C (child version of STAI), Ottawa mood and Ottawa stress scales, and Wong-Baker faces pain scale were applied and serum cortisol was measured.Group 2 children had significantly less (p0.001) stress, anxiety, and pain and improved mood. Group 2 parents had a significant reduction in state anxiety (42 ± 4.4 v 54.5 ± 7.8; p0.001) and ICS score (68.1±9.6 v 84.2 ± 9.2; p0.001) and an improvement in mood (7.5 ± 0.7 v 5.9 ± 1; p0.001) compared with group 1. Postoperatively, cortisol levels in group 2 were lower than group 1 (571.3 nmol/L [123.3 -1247.14] v 718.9 nmol/L [53-1642.0]).Providing video games and toys preoperatively reduced postoperative stress and anxiety and improved mood in children undergoing congenital cardiac surgery. Parents were relieved of anxiety and stress with proper counseling and information.

Background: Postoperative cognitive decline (POCD) after coronary artery bypass grafting (CABG) is a common problem. Studies show that pentoxifylline administration reduces inflammation induced by cardiopulmonary bypass and brain injury after ischaemia. Hence the perioperative use of pentoxifylline in attenuating POCD was evaluated in the study. Materials and Methods: Eighty patients were divided randomly into two groups from 106 patients scheduled for CABG surgery. The study group was administered pentoxifylline 400 mg twice daily orally from day of admission to 7th day after surgery, whereas the control group patients received placebo. Neurocognitive assessment was assessed by an independent clinical psychologist one day after admission to hospital and again on 7th postoperative day. The data was analyzed and a P < 0.05 was considered significant results. Results: Pentoxifylline-treated group showed no statistically significant difference in animal naming test scores (10.3 ± 2.2 versus 9.4 ± 2.5, P = 0.07), digit symbol substitution test (26.1 ± 7.47 vs 22.2 ± 6.07, P = 0.09) and 8 subtests of Post Graduate Institute-memory scale. The control group had significant POCD as detected by animal naming test (10.5 ± 3.7 versus 8.6 ± 3.9, P = 0.008), digit symbol substitution test (20.2 ± 8.2 versus 14.7 ± 8.9, P = 0.008) and five subtests of memory scale (P = 0.01, 0.04, 0.003, 0.005 and 0.02). The incidence of POCD was 50% in placebo-treated group compared to 22.5% in pentoxifylline group. Conclusions: The perioperative use of pentoxifylline attenuates the early postoperative neurocognitive decline after CABG using cardiopulmonary bypass.

Preoperative anxiety is a major and under reported problem in children A child cannot express the degree of anxiety to their parents or medical care providers Anxiety from parents can also transmit to their children Persistence of anxiety in preoperative period results in poor perioperative outcome Anesthetists should be able to play a major role in identifying and managing the preoperative anxiety in children nbsp

Objective: This study was conducted to compare the cardiac output by using Electrical Cardiometry (EC), a noninvasive method of continuous cardiac output monitoring during cardiac surgery with pulmonary artery catheter (PAC) derived cardiac output. Design: Prospective observational clinical study. Setting: Cardiac surgery operating room of a tertiary care cardiac center. Participants: Twenty five patients undergoing coronary artery bypass surgery with cardiopulmonary bypass. Measurements and Main Results: A total of 150 double data of cardiac output were compared with Thermodilution Cardiac Output (TDCO) and Thoracic Electrical Bioimpedance (TEBCO). The TDCO value ranges from 1.8-6.9 litre·min－1 with a mean of 4.39 ± 1.16 litre·min－1 and TEBCO ranges from 1.8-7.1 litre·min－1 with a mean of 4.21 ± 1.16 litre·min－1. The averaged Bland-Altman analysis for TDCO and TEBCO revealed that a mean bias was 0.18 and limit of agreement was －1.25 - 0.89 litre·min－1 and the percentage error (PE) ranged from 22%-32%. The precision for the TDCO was measured to be ±16.2% and the precision for TEBCO was ±19.6%. Receiver Operating Characteristic (ROC) curve analysis between TDCO and TEBCO with a cutoff of 15% shows a sensitivity of 84% and specificity of 63 and area under ROC curve of 0.80. Mountain plot between TDCO and TEBCO shows that a median percentile is 0.25 and value of 97.5 percentile is 1.525. Conclusions: The present study indicates that the electric cardiometry device yields numerically comparable results to cardiac outputs derived from the PAC during the cardiac surgery. Therefore, electrical cardiometry can be used to evaluate haemodynamic variables with clinically acceptable accuracy, when invasive methods are to be avoided or not available.

The formation of thrombus after Fontan operation is a lifethreatening situation. The clinical manifestations by the patient may not reflect the true diagnosis of thrombosis. Transesophageal echocardiographic evaluation is an option to delineate the vena cava anastomosis and the Fontan conduit in different views. We used transesophageal echocardiography (TEE) to detect the thrombus site prior to surgery and guided for a successful removal of thrombus. The successful surgical revision of the anastomosis was confirmed by TEE. How to cite this article Das S, Ladha S, Airan B. Role of Intraoperative Transesophageal Echocardiography in Evaluation of Fontan Conduit for Thrombosis. J Perioper Echocardiogr 2015;3(2):55-57.