Abstract
Two neonates undergoing arterial switch procedure developed life-threatening pulmonary hypertension intraoperatively. In one patient, bradycardia, hypotension, and electrocardiographic (ECG) evidence of myocardial ischemia suddenly occurred 20 minutes after uneventful weaning from cardiopulmonary bypass. Lifting a palpably hypertensive main pulmonary artery (MPA) resulted in reproducible hemodynamic improvement. Because the patient was already on full ventilatory support and a nitroglycerin infusion, the MPA was suspended onto the anterior chest wall. In the other patient, after removal of intraoperative drapes, severe generalized swelling and cyanosis were noted. The central venous pressure had risen to 25 mmHg, and the PO2 had dropped to 52 mmHg on 100% FIO2. The systolic arterial pressure and ECG remained normal. Immediate reexploration revealed a palpably hypertensive MPA. The coronary arteries implanted more laterally on the neoaorta were uncompromised. Amrinone loading and infusion produced immediate improvement. We believe that surgeons should be aware that pulmonary hypertension can cause coronary artery compression and right heart failure in neonates undergoing the arterial switch procedure. Lateral placement of the coronary artery and aggressive use of pulmonary vasodilators can minimize the problem.
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References
Castaneda A (1991) Arterial switch operation for simple and complex TGA—indication criterias and limitations relevant to surgery.Thorac Cardiovasc Surg 39:151–154
Castaneda AR, Norwood WI, Jonas RA, et al (1984) Transposition of the great arteries and intact ventricular septum: anatomical repair in the neonate.Ann Thorac Surg 38:438–443
Chang AC, Wernovsky G, Kulik TJ, Jonas RA, Wessel DL (1991) Management of the neonate with transposition of the great arteries and persistent pulmonary hypertension.Am J Cardiol 68:1253–1255
Cheitlin MD, DeCastro CM, McAllister HA (1974) Sudden death as a complication of anomalous left coronary origin from the anterior sinus of valsalva: a not-so-minor congenital anomaly.Circulation 50:780–787
DeLeon SY, Idriss FS, Ilbawi MN, et al (1988) Comparison of single versus multidose blood cardioplegia in arterial switch procedures.Ann Thorac Surg 45:548–553
Gersony WM (1984) Neonatal pulmonary hypertension: pathophysiology, classification and etiology.Clin Perinatol 11:517–524
Hickey PR, Hansen DD (1989) Pulmonary hypertension in infants: postoperative management. In: Yacoub M (ed)Annual of Cardiac Surgery. Current Science, Philadelphia, pp 16–22
Hopkins RA, Bull SG, Haworth MR, de Leval, Stark J (1991) Pulmonary hypertensive crises following surgery for congenital heart defects in young children.Eur J Cardiothorac Surg 5:628–634
Idriss FS, Ilbawi MN, DeLeon SY, et al (1988) Arterial switch in simple and complex transposition of the great arteries.J Thorac Cardiovasc Surg 95:29–36
Idriss FS, Ilbawi MN, DeLeon SY, et al (1988) Transposition of the great arteries with intact ventricular septum: arterial switch in the first month of life.J Thorac Cardiovasc Surg 95:255–262
Jatene AD, Fontes VF, Souza LCB, et al (1982) Anatomic correction of transposition of the great arteries.J Thorac Cardiovasc Surg 83:20–26
Kanter KR, Anderson RH, Lincoln C, Rigby ML, Shinebourne EA (1985) Anatomic correction for complete transposition and double-outlet right ventricle.J Thorac Cardiovasc Surg 90:690–699
Klitzner TS (1990) Sudden cardiac death in children.Circulation 82:629–632
Lupinetti FM, Bove EL, Minich LL, et al (1992) Intermediate-term survival and functional results after arterial repair for transposition of the great arteries.J Thorac Cardiovasc Surg 103:421–427
Pacifico AD, Stewart RW, Bargeron LM (1983) Repair of transposition of the great arteries with ventricular septal defect by an arterial switch operation.Circulation 68: (Suppl II):49–55
Pearl JG, Rosenthal MH, Schroeder JS, Ashton JPA (1983) Acute hemodynamic effects of nitroglycerin in pulmonary hypertension.Ann Intern Med 99:9–13
Quaegebeur JM, Rohmer A, Ottenkamp J, et al (1986) The arterial switch operation: an eight-year experience.J Thorac Cardiovasc Surg 92:361–384
Rich S, Ganz R, Levy FS (1983) Comparative actions of hydralazine, nifedipine, and amrinone in primary pulmonary hypertension.Am J Cardiol 52:1104–1107
Rudolph AM (1974) The pre-and postnatal pulmonary circulation. In:Congenital Diseases of the Heart: Clinical-Physiologic Considerations in Diagnosis and Management 1974. Year Book, Chicago, pp 29–49
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Freeman, J., DeLeon, S.Y., Miles, R.H. et al. Acute pulmonary hypertension complicating the arterial switch procedure. Pediatr Cardiol 16, 297–300 (1995). https://doi.org/10.1007/BF00798066
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DOI: https://doi.org/10.1007/BF00798066