Common congenital cardiac disease with uncommon postoperative complication

Abstract

A boy was born at term, in good condition, with an antenatal cardiac diagnosis. The diagnosis was confirmed on echocardiography. Initial genetic bloods were taken including karyotype and fluorescence in situ hybridisation and he was discharged with outpatient follow-up. He was reviewed in clinic at 5 months of age. On examination, his saturations were 85% with a normal first heart sound, soft second heart sound and a loud ejection systolic murmur. The bloods showed a normal karyotype and 22q11 status. Following a local joint cardiac meeting he was accepted for surgical repair. Figures 1 and 2 are his preoperative and postoperative chest radiographs (CXRs). Figure 1 Preoperative chest radiograph. Figure 2 Chest radiograph taken first day postoperatively. 1. What is the most likely underlying cardiac diagnosis? 2. What potentially life-threatening presentation of this condition needs to be monitored for before surgical correction? 3. What is the most prominent complication that is seen on the postoperative CXR? 4. What are the management options for this? Answers to the questions are on page …