Coronary artery spasm in a neonate with transposition of great arteries: A rare complication and reason for heart transplant

Neha Bansal, Ralph E. Delius, Sanjeev Aggarwal

Research output: Contribution to journalArticle

Abstract

Arterial switch operation has become the standard of care for d-transposition of great arteries and has excellent short- and long-term outcomes. We report the case of a newborn with a diagnosis of d-transposition of great arteries with intact ventricular septum and a low-risk coronary artery anatomy who developed coronary artery vasospasm while coming off bypass following arterial switch operation in the operating room. The coronary artery spasm led to severe biventricular dysfunction and need for extracorporeal membranous oxygenation support. Despite extracorporeal membranous oxygenation and inotropic support, there was no improvement in the left ventricular function, and cardiac transplantation was performed after 8 days. The explanted heart showed extensive infarction of both ventricles. Both the coronary ostei were patent with no evidence of thrombus, suggesting coronary artery vasospasm rather than embolus or thrombus formation. This is the first case of coronary artery vasospasm in a neonate with d-transposition of great arteries leading to cardiac transplantation. We speculate that early identification of patients who are at a high risk for coronary vasospasm and prophylactic or timely infusion of papaverine directly into the coronary arteries may be beneficial in this condition.

Original languageEnglish (US)
Pages (from-to)163-167
Number of pages5
JournalCardiology in the Young
Volume28
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Keywords

  • cardiac transplantation
  • newborn
  • Transposition of great vessels

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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