Page 20 - Journal of Structural Heart Disease Volume 5, Issue 1

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Case Report
Figure 2. Lateral angiogram following percutaneous coronary angioplasty with cranial and LAO angulation of the LMCA ob- tained with a non-tapered angled coronary guide catheter. The initial segment of the LMCA has improved filling and caliber. The proximal part of the LAD and the circumflex arteries are also seen.
ejection fraction of 73%. The patient was discharge home 1 month after the procedure. At a follow-up vis- it, five months after the percutaneous coronary artery angioplasty, echocardiogram showed optimal flow through the coronary arteries, normal left ventricular systolic function with ejection fraction of 59%.
Discussion
The ASO has become the standard method for sur- gical correction of TGA since its introduction by Ja- tene and colleagues in 1975 [1]. Although there has
been a significant decrease in morbidity and mortal- ity rates when compared to the atrial switch proce- dure operation and long-term outcomes, the risk of acute and subacute coronary artery complications is well recognized after ASO [2]. Surgical revasculariza- tion of the coronary artery is usually recommended to preserve myocardial function and avoid ischemic events if coronary artery complications are observed [3]. However, consideration must be given to alter- native explanations for myocardial dysfunction es- pecially after a period of weeks of normal recovery. The use of glutaraldehyde fixed hemostats should be avoided as evidenced by the inflammation of the cor- onary arteries in our patient. The case suggests that percutaneous coronary artery angioplasty may be an alternative to highly surgically demanding coronary artery revascularization in a small infant. Our experi- ence shows that coronary artery balloon dilation can be performed safely and effectively in infants with inflammatory stenosis of the coronary arteries even on ECMO. Stent angioplasty was not possible in this infant due to the extremely small size of the coronar- ies. The potential for coronary in-stent restenosis and need for further repeated interventions with growth was also a concern. The prompt suspicion of coronary artery complications after ASO and timely interven- tion can rescue the left ventricular function and re- sult in a complete recovery with optimal long-term outcomes. Percutaneous angioplasty must be consid- ered in infants with post-operative coronary stenosis.
Conflict of Interest
The authors have no conflict of interest relevant to this publication.
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Sowinski H. A. et al.
Percutaneous Angioplasty of Coronary Obstruction in an Infant