A case of fatal septic pulmonary embolus arising from an infected Sano conduit

A 5-month-old boy who had previously undergone a modified Norwood procedure for hypoplastic left heart syndrome presented for elective cardiac catheterization before undergoing the next stage of repair. The catheterization demonstrated mild stenosis of the right ventricle-to-pulmonary artery Sano conduit. The patient became hypoxic and febrile at the end of the procedure and died in the intensive care unit the next day. Postmortem examination demonstrated a vegetation containing Gram-positive cocci in the conduit and a right upper lobe lung abscess also containing Gram-positive cocci. The authors report the first case of Sano shunt endocarditis further complicated by septic pulmonary embolus and review similar infections in this population. Shunt infection may be an underrecognized cause of interstage mortality among patients undergoing a modified Norwood procedure.