Patient with aortic stenosis and ischemic heart disease undergoing excision of oral cavity malignancy: A case report

Aortic stenosis is a progressive valvular heart disease with significant implications in perioperative management. Patients with aortic stenosis undergoing noncardiac surgeries (1), (2) may require meticulous monitoring throughout the perioperative period. Ischaemic heart disease (IHD) is a dynamic process of atherosclerosis of the coronary arteries or functional alterations of coronary circulation and these patients may have wall motion abnormalities. Here we report a case of carcinoma of buccal mucosa with aortic stenosis and IHD with restricted mouth opening posted for wide local excision of the tumour, hemimandibulectomy and reconstruction with pectoralis major flap. Airway assessment shows Mallampati grade 4 and had an anticipated difficult airway. Hence, awake fibreoptic endotracheal intubation was done by following airway blocks, and an 8.0 mm cuffed flexometallic armored tube was secured. This case report details the multidisciplinary perioperative management approach for a patient with severe AS and ischemic heart disease (IHD) undergoing oral cavity malignancy excision.