Accelerated calcific degeneration of homologous pericardium resulting in pulmonary venous obstruction following senning procedure

Abstract

Two and half year old child presented with a historyof failure to thrive, tachypnea on exertion and wasdiagnosed to have congestive heart failure. Transthoracic echocardiography (TTE) revealed severepulmonary ventricular dysfunction, with pulmonaryvenous baffle obstruction (PVBO) (gradient 20 mmHg)and severe pulmonary arterial hypertension. The childhas a previous history of Senning operation done at theage of nine months for complete transposition of greatvessels with intact ventricular septum. Senningprocedure was chosen as the child had neonatalrespiratory complications and was lost to follow up afterballoon septostomy, we do not have any experience withthe rapid two stage arterial switch procedure. Senningoperation was done with standard aortic and bicavalcannulation with deep hypothermia and low flows. Thepulmonary venous chamber was augmented withautologous pericardium. Postoperative TTE did notshow any obstruction. The child presented a year later