Late post-operative cardiogenic shock from left main coronary compression in tetralogy of Fallot with absent pulmonary valve: a case report

Left main coronary artery compression after surgical pulmonary valve replacement in TOF-APV occurring few days after the operation may pose diagnostic and therapeutic challenges. Exact mechanism for post-operative compression is not known. It can be hypothesized that the ionotropic agents used in post-operative period, or change in the geometric relationships of pulmonary artery and LMCA due to pulmonary valve implantation, brought out the compression. A case for prophylactic PA size reduction can be made to avoid the possibility of LMCA compression.