Newborn Shunt Occlusion

5-week-old baby girl with prenatal diagnosis of hypoplastic left heart syndrome, status post Norwood with a 3.5mm BTT shunt at DOL5. Her intraoperative and postoperative course was relatively unremarkable. She had been in the hospital for two weeks post-op, working on feeding issues. Discharge echo demonstrated good ventricular function with trivial tricuspid regurgitation. She has now been home for about 10 days, and over the past 24 hours mom reports the baby hasn’t been feeding as well. She’s had several episodes of emesis as well. The O2 sats on the home monitor have been in the low 80s, but mom brought the baby in due to the emesis this morning. Scenario begins with relatively stable vital signs, and a baby that appears pink. The baby needs to have a loud shunt murmur on exam. An IV should already be in place. Overall goal is to perform the objectives below, and notify the CICU about a patient with a surgical emergency.

Additional information




Children's National

Case Setting

Emergency Department


Emergency medicine, Pediatrics




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