My Biggest Fear: Coronary Compression After An Arterial Switch Operation
Ismail Bouhout, Damien Lapar, Amelia Burke, David Kalfa, Emile Bacha.
Columbia University, NEW YORK, NY, USA.
We describe a full-term baby with a diagnosis a Taussig-Bing Anomaly. The right coronary and the left anterior descending arteries were arising from the sinus 1 while the circumflex (Cx) rose from the sinus 2. The patient underwent a VSD closure and arterial switch. Because of concern for coronary compression, the distal anastomosis of the MPA was shifted rightward. After the repair, the patient could not to be separated from the cardiopulmonary bypass machine. The intraoperative echocardiogram revealed severe LV dysfunction and severe MR. LPA patch plasty was done to improve the neopulmonary root mobility and give more space around the Cx. The patient left the OR on ECMO. Catheterization showed patent coronaries with a stretched LPA over the large neo-aortic root. The patient was taken back to the OR on day 2 for a LPA stenosis repair with a 6mm interposition graft, also as treatment for a suspicion for ongoing subclinical Cx compression. ECMO was successfully weaned a week postoperatively. The patient made small progress and was extubated 1 month postoperatively. Subsequently, she developed systemic RV pressure with ongoing severe LV dysfunction. Repeat catheterization showed patent Cx but smaller diameter proximally vs distal. She underwent replacement of her MPA with a pulmonary homograft. LV function did not improve and the patient developed advanced heart failure and was listed for transplantation. Thereafter, a biventricular ventricular assist device was placed for deteriorating hemodynamic status. After two months of support, she developed a multiorgan failure syndrome and died 6 months after surgery.
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