Intraoperative Anaphylaxis in the Setting of Undiagnosed Alpha-Gal Syndrome

Figures

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  Figure 1. Preoperative Parasternal Long-Axis View Echocardiogram This figure shows the patient's heart in the preoperative period and is meant to guide the reader to relevant structures when viewed from the parasternal long-axis view. This view demonstrates a heavily calcified aortic valve, which is seen to have poor systolic movement in subsequent videos. Ao = aorta; AoV = aortic valve; LA = left atrium; LV = left ventricle; MV = mitral valve; RVoT = right ventricle.

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  Figure 2. Preoperative and Postoperative Proximal Aorta Computed tomography images demonstrating (A) the proximal aortic aneurysm measuring 49 mm at its widest point compared with (B) the postoperative Gelweave transplant in the area of the proximal aorta measuring 30.5 mm at its widest point.

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  Figure 3. Bioprosthetic Aortic Valve in the Immediate Postoperative Period This still image taken from an intraoperative TEE shows the bioprosthetic aortic valve shortly after it was installed. The valve opens and closes well, and there is no evidence of unseating or leaflet dysfunction. TEE = transesophageal echocardiogram.

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  Figure 4. Parasternal Long-Axis View 4 Months Postoperatively This image is a parasternal long-axis view transthoracic echocardiogram showing the closed and open positions of the aortic valve 4 months after its installation. There is no evidence of calcification or stenosis of the valve, and it can be seen opening freely.