Congenital Heart Surgeons' Society

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Coronary Artery Thromboembolism After Norwood Procedure
Ali Ibrahimiye, James Hammel.
Childrens hospital and Medical Center Omaha, Omaha, NE, USA.

Objective(s): We are reporting an unusual and challenging case of left and right coronary artery thromboembolism 3 weeks after an uncomplicated Norwood operation.
Methods: Patient was a full term 2.8kg neonate with HLHS (MS/AA). On day of life 4 he underwent an uncomplicated Norwood procedure with RV to PA shunt. The cross clamp time was 31 min, bypass time was 139 min.
Results: Although patient initially did well, he failed to make progress in terms of weaning from sedation or coming off the ventilator. Any attempt would result in decrease in NIRS and increase in lactate suggesting impaired cardiac output. TTE and EKG were normal during those episodes. Cardiac Catheterization 18days post op showed 90 percent occlusion of both left main and mid right coronary arteries. Patient was emergently taken to the OR. We found a thrombus in the native aortic root part of which had embolized in both coronary systems. We performed a thrombectomy.
Conclusions: This is a rare and challenging case of coronary thromboembolism following Norwood operation. It demonstrates the importance of early cardiac catheterization and aggressive operative management.