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Pulmonary Atresia With Intact Ventricular Septum and Right Ventricle-Coronary Fistula: Transesophageal
Yi-Chia Wang1, Chi-Hsiang Huang1, Shu-Chien Huang2
1Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Images:
Pulmonary atresia with intact ventricular septum and right ventricle (RV)-to-coronary fistula were assessed using intraoperative transesophageal echocardiography (TEE).
Case Summary:
A neonate with pulmonary atresia with intact ventricular septum and extensive RV-coronary communications underwent surgery. Intraoperative TEE showed retrograde right coronary flow; temporary fistula clamping restored antegrade flow without ventricular dysfunction, permitting safe ligation, tricuspid valve plasty, and RV-pulmonary artery reconstruction.
Take-Home Messages:
Intraoperative TEE can confirm coronary perfusion in real time during fistula test clamping. It helps determine whether RV decompression can be performed safely.
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