ST Segment Elevation Immediately After Cardiopulmonary Bypass During Modified Blalock-Taussig Shunt and Pulmonary Artery Banding.

A 35-day-old boy with double-outlet right ventricle, infravalvular pulmonary stenosis, atrial septum defect, right aortic arch, and total anomalous pulmonary venous return was scheduled for main pulmonary artery transection with modified Blalock-Taussig shunt owing to repetitive anoxic spells. After median sternotomy, the left anterior descending coronary artery was found to branch off the right coronary artery. As a result, the surgeon decided to preserve the pulmonary valve to allow for the placement of a smaller right ventricle–pulmonary artery conduit as part of a future modified Rastelli surgery. An expanded polytetrafluoroethylene graft was sutured to the left brachiocephalic artery and main pulmonary artery. The proximal side of the main pulmonary artery was tightened (pulmonary artery banding) using polytetrafluoroethylene nonabsorbable monofilament thread. Cardiopulmonary bypass was successfully weaned with inotropic support, but ST-segment elevation in lead Ⅱ was observed (Fig 1A). Coronary artery occlusion by the pulmonary artery band was suspected, but echocardiography showed normal biventricular wall motion. The electrocardiogram (ECG) patches were examined. The patch attached to the right shoulder was soaked in blood (Fig 1B). A normal ECG was observed after the replacement and reattachment of this electrode (Fig 1C). Krasnow et al. also reported that intermittent skin-electrode contact caused electrocardiographic artifacts that mimicked ventricular tachycardia and ST-elevation.1Krasnow A Bloomfield D. Artifacts in portable electrocardiographic monitoring.Am Heart J. 1976; 91: 349-357Crossref PubMed Scopus (60) Google Scholar Our case illustrates that ST-segment elevation does not always indicate myocardial ischemia and comprehensive evaluation is critical to determining the exact etiology of ECG abnormalities. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.