A 3-year-old boy with known congenital heart disease was admitted to the hospital in respiratory distress. Cyanotic at birth, he was found to have D-transposition of the great vessels for which an immediate atrial septostomy was performed. At 14 months of age, a Mustard procedure was accomplished without apparent complication. A neurologic examination at 18 months of age revealed mild right hemiparesis and developmental delay. A brain computed tomographic (CT) scan demonstrated old left paraventricular and left occipital infarcts.
The patient's respiratory distress was identified as pulmonary vascular congestion and interstitial edema secondary to obstruction of the surgical intracardiac baffle.
During the surgery to repair the baffle, the boy suffered a brief cardiac arrest while being placed on the cardiac bypass pump. Following surgery he failed to regain consciousness. On neurologic examination, his pupils were midsize and reactive to light, and his deep tendon reflexes were hyperactive. A CT head