Acute ST changes during anesthesia induction 10 months after Norwood procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Interventional Cardiology

Background:

• The Norwood procedure is a palliative surgery for hypoplastic left heart syndrome (HLHS).
• Significant interstage and late mortality persist after the Norwood procedure, with unclear causes.
• Coronary insufficiency due to aortic arch stenosis is an under-recognized complication.

Observation:

• A 10-month-old infant, status post bidirectional Glenn, developed acute ischemic changes on ECG during anesthesia for elective surgery.
• The infant was previously thriving following HLHS palliation.
• A discrete narrowing at the native aorta to neo-aorta anastomosis was identified.

Findings:

• The narrowing was attributed to kinking or scarring at the anastomosis site.
• Emergent stenting was required to restore adequate coronary blood flow.
• Simple balloon angioplasty failed to adequately improve the stenosis.

Implications:

• This case highlights the importance of recognizing and managing aortic arch stenosis post-Norwood procedure.
• Early identification and intervention, such as stenting, can prevent adverse cardiac events.
• Further research into the incidence and optimal management of this complication is warranted.