[Acute coronary syndrome due to abnormal fibrous tissue growth after Aubert-Imai modification for transposition of the great arteries].

The study is about an infant who experienced a severe heart condition, known as acute coronary syndrome, after undergoing a specific operation for a congenital heart defect. This problem was due to the abnormal growth of fibrous tissue post-surgery and required another emergency operation to rectify.

Background of the Patient

• The patient was a baby girl who had undergone a surgical method known as the Aubert-Imai modification. This procedure is used for treating a congenital heart condition called transposition of the great arteries, where the two main arteries leaving the heart are reversed.

Postoperative Developments

• Two months after her surgery, the infant was brought to the emergency department due to excessive perspiration and rapid breathing, also known as tachypnea.
• A blood chemistry examination was performed which confirmed the diagnosis of acute coronary syndrome, a severe heart condition caused by a blockade in the coronary arteries that deprive the heart muscle of blood and oxygen. Acute coronary syndrome can result in angina (chest pain) or a heart attack.

Findings and Emergency Operation

• A cardiac catheterization study, a diagnostic procedure to examine how well the heart is working, unveiled the cause of her condition. This showed that there was a restricted, or stenosed, Aubert route (the pathway created for the blood to flow during the original operation).
• Also, it was discovered that the opening between the aorta and pulmonary artery (called the aortopulmonary window) was almost completely blocked by fibrous tissue.
• The fibrous tissue had grown from the patch made of equine pericardium (the membrane enclosing the heart in horses) used during her original operation.
• Due to these findings, an emergency operation was immediately carried out. During this operation, the researchers were able to remove all the fibrous tissue, and they deepened the aortopulmonary window to enlarge the opening of the coronary artery (coronary ostium).

Recommendations moving forward

• After this case, the researchers advised that patients who undergo similar operations should have close follow-up monitoring. More specifically, they recommended the use of angiography, an imaging technique used for visualizing blood vessels, after these procedures to monitor for any potential complications.