ST Segment-Elevation Myocardial Ischemia After Arterial Switch Operation due to Pericardial Drain Placement: A Case...

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Congenital Heart Disease

Background:

• Arterial switch operation (ASO) is a common surgical procedure for D-transposition of the great arteries.
• Myocardial ischemia is a known complication of ASO, typically attributed to coronary artery issues.

Observation:

• A 5-week-old infant developed myocardial ischemia post-ASO, indicated by ST segment elevation and abnormal cardiac wall motion.
• The ischemia occurred shortly after the placement of a pericardial drain.

Findings:

• Withdrawal of the pericardial drain and repositioning it in the retrosternal space led to significant improvement in ST segments and cardiac wall motion.
• This suggests that the pericardial drain itself, not just coronary artery translocation, can cause myocardial ischemia after ASO.

Implications:

• Highlights a rare but significant complication of pericardial drain placement following ASO in pediatric patients.
• Suggests careful consideration and monitoring of drain placement in infants undergoing ASO to prevent myocardial ischemia.
• Underscores the need for further investigation into the mechanisms by which pericardial drains can compromise myocardial function post-ASO.