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Massive haemorrhage at resternotomy after stent implantation in ventriculo-pulmonary shunt after Norwood procedure

^a Department of Cardiothoracic Surgery, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
^b Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
^c Department of Pediatric Cardiology, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

*Corresponding author. Tel.: +31 40 2398680; fax: +31 40 2440268.

E-mail address: suzanne.kats{at}catharina-ziekenhuis.nl (S. Kats).

The ventriculo-pulmonary shunt in hypoplastic left heart syndrome has become an alternative to the arterio-pulmonary shunt. We present a patient with a severe stenosis in the ventriculo-pulmonary shunt at the proximal anastomosis, for which emergency balloon dilatation and stent implantation was performed. The location of the stent in the shunt, leaving only a thin compressed infundibular myocardium directly beneath the sternum, predisposed to massive haemorrhage at resternotomy for bidirectional Glenn procedure.

Key Words: Hypoplastic left heart syndrome; Ventriculo-pulmonary shunt; Balloon dilatation; Stent