Erupted abscess cavity and stenosed pulmonary homograft in repeated radical sternotomies: Anaesthesia and haemodynamics control

Congenital heart disease affects approximately 1% of the population and is the leading cause of birth defect associated infant illness and death. The most common cyanotic heart disease is tetralogy of Fallot (TOF) which is characterized by overriding of aorta, ventricular septal defect (VSD), pulmonary stenosis and right ventricular hypertrophy. TOF are repaired early in infancy and involves closure of the VSD and repair or replacement of the pulmonary valve to improve right ventricular outflow. A potential and significant complication is stenosis of the pulmonary homograft. We discuss a young patient with previous sternotomies for repair of TOF presenting for his 4th redo-sternotomy for an infective abscess near his old pulmonary homograft. This case presents to us multiple challenges such as a septic patient, previous sternotomies and a potential for intraoperatively massive blood loss.