Gastric transposition for esophageal replacement in children seems to produce favorable results [1]. We wish to highlight a problem that we have been facing following gastric pull-up surgery for esophageal substitution in children (both for caustic esophageal stricture and pure esophageal atresia). Transient tachycardia was frequently observed postoperatively, which resolved over the course of time with no adverse sequelae. However, two of our patients, aged 3 years, developed marked tachycardia as soon as the stomach was pulled into the chest. The heart rate rose above 180 beats/min and remained there despite adequate volume (fluid and blood) replacement, analgesia, and maintenance of normothermia. Preoperative echocardiography had shown no congenital cardiac anomaly. We put these patients on elective mechanical ventilation postoperatively with continuous morphine analgesia. The tachycardia was narrow-complex, sinus and was persistent and nonresponsive, with little variation in the rate. It worsened gradually in the postoperative period, resulting in both patients in cardiac arrest between 24 and 48 h after surgery.

In another patient, aged 1 year, we faced the same problem of severe tachycardia after gastric pull-up for long-gap esophageal atresia. Adequate fluid compensation, ventilation, and analgesia were maintained, but the tachycardia persisted postoperatively. A 12-lead electrocardiogram confirmed it to be sinus tachycardia.