In neonates with severe coarctation of the aorta (CoA) left ventricular function is impaired. Successful repair of CoA usually dissolves the problem. In our patient after successful repair of critical CoA endocardial fibroelastosis occurred. Cardiac Troponin T (cTnT) didn`t normalise. Catherisation revealed anomalous origin of left coronary artery (LCA) from the right pulmonary artery (ALCAPA) and anomalous drainage of the coronary sinus (CS) via a left persistent caval vein superior (LSVC)
10 day old neonate (w 4550g, h 56cm), gradient between the upper and lower extremities 30 mmHg. Echocardiographic diagnosis: critical CoA without a patent duct (LVIDd 1,2 cm, FS 18 %). Repair of CoA the following day with end to side anastomosis. On second day after surgery global organ dysfunction occured, Adenovirus infection was suspected but could`nt be proven. No evidence for recoarctation but signs for endocardial fibroelastosis (LVIDd 1,8 cm, FS 28%). Due to not normalised cTnT after recovering catherisation was done and showed an ALCAPA, additionally CS drainage to a LSVC. LCA was reimplanted to the left posterior part of the aorta, the right pulmonary artery was patched with autologous pericardium.
The impact of cTnT in pediatric patients as a marker for myocardial injury is well known. In our patient left ventricular function was nearly normalised but cTnT was not normal after 4 weeks. cTnT seems to be a good indicator in case of residual problems with myocardial perfusion even after surgery. Catheterisation has to be done to exclude additional malformations of the coronary vessels.