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.