Page 18 - Journal of Structural Heart Disease Volume 5, Issue 1

Case Report
Journal of Structural Heart Disease, February 2019, Volume 5, Issue 1:7-10
DOI: https://doi.org/10.12945/j.jshd.2019.013.18
Received: April 27, 2018 Accepted: May 15, 2018 Published online: February 2019
Percutaneous Angioplasty of Coronary Obstruction in an Infant on Extracorporeal Membrane Oxygenation
Heather A. Sowinski, DO1,2, Bennett P. Samuel, MHA, BSN, RN1, Vishal R. Kaley, MBBS, MD1,
E. Oliver Aregullin, MD, FAAP1,2, Giedrius Baliulis, MD1,2, Neal D. Hillman, MD1,2,
Marcus P. Haw, MBBS, FRCS, FECTS1,2, Joseph Vettukattil, MBBS, MD, DNB, CCST, FRCPCH, FRSM, FRCP1,2*
1 Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA 2 College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
Abstract
The arterial switch operation (ASO) is the standard surgical technique for transposition of the great ar- teries. Although there have been significant improve- ments in long-term outcomes in patients undergoing the ASO when compared to the atrial switch procedure (Mustard or Senning), early and mid-term morbidi- ty and mortality due to coronary complications have been identified. We describe percutaneous coronary artery angioplasty in a 9-week-old infant on extracor- poreal membrane oxygenation status post ASO with optimal outcomes.
Copyright © 2019 Science International Corp.
Key Words
Arterial switch operation • Coronary artery • Percutaneous coronary angioplasty.
Introduction
Coronary artery complications may contribute to significant morbidity and mortality after the arterial switch operation (ASO). If coronary artery compli- cations are present, revision of coronary buttons or surgical revascularization is usually performed to pre- serve myocardial function and avoid ischemic events. We report successful percutaneous coronary artery
angioplasty with optimal long-term outcomes in an infant after ASO.
Case Presentation
A 9-week-old male infant post-surgical repair of double outlet right ventricle (DORV) and transposi- tion of the great arteries (TGA) presented to our emer- gency department (ED) with cyanosis, and respirato- ry distress following a brief episode of poor feeding and emesis. Born at 39-weeks gestation by caesarean section at 3.12 kg, he had prenatal diagnosis of TGA. A postnatal echocardiogram confirmed the diagnosis of DORV with TGA, inverted coronary pattern, large perimembraneous ventricular septal defect (VSD) with inlet extension, subpulmonary stenosis due to muscle bundles, and patent ductus arteriosus. He was discharged to home with stable oxygen satura- tions and plan for close monitoring, but readmitted at age of 3 weeks requiring balloon atrial septostomy due to significant cyanosis. Surgical repair was per- formed at age 5 weeks and included ASO, closure of VSD and relief of subpulmonary stenosis by resecting the right ventricular outflow tract muscle bands. His post-operative course was complicated by abdomi- nal ascites requiring peritoneal drainage placement. He was discharged to home on post-operative day 10
* Corresponding Author:
Joseph Vettukattil, MBBS, MD, DNB, CCST, FRCPCH, FRSM, FRCP Congenital Heart Center
Spectrum Health Helen DeVos Children’s Hospital
100 Michigan NE (MC48), Grand Rapids, Michigan 49503 , USA Tel. +1 616 267 0988; Fax: +1 616 267 1408;
E-Mail: joseph.vettukattil@helendevoschildrens.org
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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