Right coronary artery territory ischemia after pulmonary artery banding
in univentricular physiology with transposition of great arteries
Abstract
Pulmonary artery (PA) band is done in a variety of congenital heart
diseases (CHDs) with the primary goal of reducing pulmonary
overcirculation. Its use has declined during the last two decades,
however, its role still exists in classic univentricular heart with
unrestricted pulmonary blood flow. PA banding in univentricular
morphology with transposition of great arteries (TGA) can be extremely
morbid. Our patient had ST segment elevation in inferior leads after
banding, indicating acute ischemia in right coronary artery territory.
We hypothesize that, the cause for this was sudden shift of volume to
the rudimentary camber through the bulboventricular foramen after PA
banding, causing subendocardial ischemia. Interpretation of
electrocardiogram (ECG) and subsequent management is not straightforward
in this scenario .We hereby describe successful management of sudden ST
segment changes observed in immediate post-operative period after PA
banding for univentricular, TGA heart in an 8 month old infant.