IMAGES: Pulmonary atresia with intact ventricular septum and right ventricle (RV)-to-coronary fistula were assessed using intraoperative transesophageal echocardiography (TEE). CASE SUMMARY: A neonate with pulmonary atresia with intact ventricular septum and extensive RV-coronary communications underwent surgery. Intraoperative TEE showed retrograde right coronary flow; temporary fistula clamping restored antegrade flow without ventricular dysfunction, permitting safe ligation, tricuspid valve plasty, and RV-pulmonary artery reconstruction. TAKE-HOME MESSAGES: Intraoperative TEE can confirm coronary perfusion in real time during fistula test clamping. It helps determine whether RV decompression can be performed safely.
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Wang et al. (2026) studied this question.
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