Case 7 History ---- The patient was a 14 month old girl with history of severe congenital heart disease. She was diagnosed with hypoplastic left heart syndrome with a pre-natal ultrasound. She was born at 39 weeks. Seven days after birth she had a Norwood procedure with Sano shunt surgery and spent several weeks in recovery. In July 2011 she was found to be in cardiogenic shock due to coarctation of her aorta. She was successfully resuscitated and placed on ECMO. Her aorta was dilated with a balloon and a stent was placed. She underwent cardiac catheterization on 9/29 to evaluate a planned Glenn procedure but her anatomy was not conducive for that procedure. During the procedure her aortic stent and pulmonary arteries were dilated in response to recurrent stenosis. In March 2012 she underwent a procedure to reconstruct her pulmonary artery and create a systemic to pulmonary arterial shunt. Recovery was complicated by cardiac tamponade requiring an additional operative procedure a few days later, but she eventually recovered. In July she was visiting her grandmother and stopped breathing. The car taking her to the ER was involved in a car accident en route. She was not in a car seat during the accident. Following the accident the continued to SLCH ED. Upon arrival it was noted that she was apneic and pulseless. Resuscitation attempts were unsuccessful. ---- The weight of the unfixed brain was 675 gm, which is within normal limit of age matched children. The patient's cardiac status was compromised by severe pulmonary branch artery stenosis and hypertrophic dilated cardiomyopathy in the background of complex congenital heart disease.
