Introduction
Pulmonary artery (PA) banding is used as a palliative treatment for infants, who are not candidates for immediate primary repair. In patients of single ventricle (SV) physiology with unrestricted blood flow, it is done as a first stage palliation to protect the lungs. PA banding in univentricular situation with transposition of great arteries (TGA), can be extremely morbid.1 Sudden onset of increase in afterload and systemic hypoxemia after PA banding, can produce ischemia in a single ventricle. But these should cause global ischemia and not regional, as observed in our patient. We believe that sudden shift of preload to rudimentary chamber after PA banding causes increased wall stress. This leads to subendocardial ischemia and hence ST segment elevation in RCA territory. New onset ischemia in a banded single ventricle, if not managed appropriately, can lead to dismal outcome. The literature highlighting its management is very limited.