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

Published online by Cambridge University Press:  08 August 2017

Neha Bansal ,
Ralph E. Delius  and
Sanjeev Aggarwal
Neha Bansal*
Affiliation:
Division of Cardiology, The Carmen and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Ralph E. Delius
Affiliation:
Division of Cardiovascular Surgery, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Sanjeev Aggarwal
Affiliation:
Division of Cardiology, The Carmen and Ann Adams Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
*
Correspondence to: N. Bansal, Division of Pediatric Cardiology, The Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, United States of America. Tel: 313 745 5481; Fax: 313 993 0894. E-mail: nehban@gmail.com
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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.

Keywords

Transposition of great vesselscardiac transplantationnewborn
Type
Brief Report
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 163 - 167
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Copyright
© Cambridge University Press 2017 

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