title: Acute ST changes during anesthesia induction 10 months after Norwood procedure.
abstract: After the Norwood procedure for palliation of hypoplastic left heart syndrome, there is still significant interstage and late mortality with often unclear etiology. An important, but possibly under-recognized complication of the Norwood operation is the potential for coronary insufficiency from pre-coronary stenosis due to kinking or scarring at the anastomosis between the native and neo-aorta. We report a case of a clinically thriving 10-month old infant status post bidirectional Glenn who had acute ischemic changes on electrocardiogram (ECG) during induction of anesthesia for elective bilateral herniorrhaphy. A discrete narrowing in the native aorta to neo-aorta anastomosis was identified. A stent was placed emergently to restore adequate coronary blood flow after failure of simple angioplasty to adequately improve the stenosis.
authors.affiliation: Department of Pediatric Cardiology and Pediatric Cardiothoracic Surgery, M-41, Cleveland Clinic Children's Hospital, Cleveland, Ohio 44195, USA. jameshillmd@gmail.com
authors.forename: James A
authors.initials: JA
authors.lastname: Hill
authors.forename: Athar M
authors.initials: AM
authors.lastname: Qureshi
authors.forename: Larry A
authors.initials: LA
authors.lastname: Latson
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects*; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001018:Aortic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003251:Constriction, Pathologic; D003326:Coronary Circulation; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D059685:Herniorrhaphy; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D058327:Norwood Procedures / Q000009:adverse effects*; D010166:Palliative Care; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome