1
|
Sullivan PM, Ing FF. Systemic Central Venous Rehabilitation in Congenital Heart Disease. Interv Cardiol Clin 2024; 13:439-450. [PMID: 38839176 DOI: 10.1016/j.iccl.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Chronic venous obstructions resulting from indwelling lines, surgery and instrumentation, and congenital anomalies are increasingly common in patients with congenital heart disease (CHD) and other chronic illnesses. Venous obstruction results in threatened long-term vascular access and congestive symptoms. Endovascular therapies are safe and can be effective at rehabilitating obstructed and even occluded veins. The risk of recurrent obstruction is high, however. Post-rehabilitation monitoring and anticoagulation therapy are important, and reinterventions are common. Here, the authors describe techniques to address a variety of venous obstruction lesions that may be encountered in CHD patients and provide illustrative cases.
Collapse
Affiliation(s)
- Patrick M Sullivan
- USC Keck School of Medicine, Los Angeles, CA, USA; Children's Hospital Los Angeles Heart Institute, 4650 Sunset Boulevard #34, Los Angeles, CA 90027, USA.
| | - Frank F Ing
- UC Davis School of Medicine, Pediatric Heart Center, UC Davis Children's Hospital, 2516 Stockton Boulevard TICON II, Sacramento, CA 95817, USA
| |
Collapse
|
2
|
A rare case of superior vena cava syndrome in a patient on VV-ECMO. Indian J Thorac Cardiovasc Surg 2022; 38:215-217. [PMID: 35002107 PMCID: PMC8723804 DOI: 10.1007/s12055-021-01293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/03/2022] Open
Abstract
Superior vena cava (SVC) syndrome is caused by either extrinsic compression of SVC or intrinsic lesions within SVC leading to obstruction of SVC and consequently swelling of the face, neck, and upper extremeities. Iatrogenic incidence is on the rise due to the use of long-term indwelling catheters. SVC syndrome in extracorporeal membrane oxygenation (ECMO) has been defined in neonatal and paediatric ECMO cases. Only one case of SVC syndrome in adult has been defined while using a double-lumen ECMO cannula. Our case describes a case of SVC syndrome in a case on veno-venous ECMO (VV-ECMO) with an internal jugular vein (IJV) return cannula which is unheard of. A high index of suspicion is required to diagnose SVC syndrome.
Collapse
|
3
|
Abstract
Superior caval vein stenosis is a known complication following paediatric heart transplantation. Herein, we sought to assess the incidence of superior caval vein stenosis and need for intervention in a single centre paediatric heart transplantation programme. A retrospective review was performed to identify variables associated with superior caval vein stenosis and need for intervention. Patients were identified based on angiographic and echocardiographic signs of superior caval vein stenosis. Of 204 paediatric heart transplantation recipients, 49 (24.0%) had evidence of superior caval vein stenosis with no need for catheter intervention and 12 (5.9%) had superior caval vein stenosis requiring catheter intervention. Overall, patients with superior caval vein stenosis with and without intervention had more cavopulmonary anastomosis (41.7%; 20.4%), pre-transplant superior caval vein procedures (41.7%; 28.6%), and bicaval approach (100.0%; 98.0%), compared to the group with no stenosis (11.9% and p = 0.015, 12.6% and p = 0.004, 73.4% and p < 0.001, respectively). Smaller recipients and donors were more likely to need intervention. Intervention was also seen more frequently in recipients who were younger at diagnosis (4.7 years) compared to non-intervention (13.3 years; p = 0.040). Re-intervention was required in 16.7% patients (n = 2) and was not associated with any complications.
Collapse
|
4
|
Kopanczyk R, Al-Qudsi OH, Ganapathi AM, Potere BR, Pagel PS. Superior vena cava syndrome during veno-venous extracorporeal membrane oxygenation for COVID-19. Perfusion 2021; 36:630-633. [PMID: 33427042 DOI: 10.1177/0267659120987973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Superior vena cava (SVC) syndrome is typically associated with malignant tumors obstructing the SVC, but as many as 40% of cases have other etiologies. SVC obstruction was previously described during veno-venous extracorporeal membrane oxygenation therapy (VV ECMO) in children. In this report, we describe a woman with adult respiratory distress syndrome resulting from infection with coronavirus-19 who developed SVC syndrome during VV ECMO. A dual-lumen ECMO cannula was inserted in the right internal jugular vein, but insufficient ECMO circuit flow, upper body edema, and signs of hypovolemic shock were observed. This clinical picture resolved when the right internal jugular vein was decannulated in favor of bilateral femoral venous cannulae. Our report demonstrates that timely recognition of clinical signs and symptoms led to the appropriate diagnosis of an uncommon ECMO complication.
Collapse
Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Omar H Al-Qudsi
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Asvin M Ganapathi
- Department of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bethany R Potere
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Paul S Pagel
- Anesthesiology Service, The Clement J Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| |
Collapse
|
5
|
Nossair F, Schoettler P, Starr J, Chan AKC, Kirov I, Paes B, Mahajerin A. Pediatric superior vena cava syndrome: An evidence-based systematic review of the literature. Pediatr Blood Cancer 2018; 65:e27225. [PMID: 29781569 DOI: 10.1002/pbc.27225] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
Superior vena cava syndrome (SVCS) results in vascular, respiratory, and neurologic compromise. A systematic search was conducted to determine the prevalence of pediatric SVCS subtypes and identify clinical characteristics/treatment strategies that may influence overall outcomes. Data from 101 case reports/case series (142 patients) were analyzed. Morbidity (30%), mortality (18%), and acute complications (55%) were assessed as outcomes. Thrombosis was present in 36%, with multi-modal anticoagulation showing improved outcome by >50% (P = 0.004). Infant age (P = 0.04), lack of collaterals (P = 0.007), acute complications (P = 0.005), and clinical presentation may have prognostic utility that could influence clinical decisions and surveillance practices in pediatric SVCS.
Collapse
Affiliation(s)
- Fadi Nossair
- Division of Oncology, CHOC Children's, Orange, California
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Peter Schoettler
- Department of Pediatrics, University of California-Irvine, Irvine, California
- Department of Pediatrics, CHOC Children's, Orange, California
| | - Joanne Starr
- Division of Cardiothoracic Surgery, CHOC Children's, Orange, California
| | - Anthony K C Chan
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ivan Kirov
- Division of Oncology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Arash Mahajerin
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| |
Collapse
|
6
|
Meani P, Delnoij T, Raffa GM, Morici N, Viola G, Sacco A, Oliva F, Heuts S, Sels JW, Driessen R, Roekaerts P, Gilbers M, Bidar E, Schreurs R, Natour E, Veenstra L, Kats S, Maessen J, Lorusso R. Protracted aortic valve closure during peripheral veno-arterial extracorporeal life support: is intra-aortic balloon pump an effective solution? Perfusion 2018; 34:35-41. [PMID: 30024298 PMCID: PMC6304680 DOI: 10.1177/0267659118787426] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Left ventricular (LV) afterload increase with protracted aortic valve (AV)
closure may represent a complication of veno-arterial extracorporeal
membrane oxygenation (V-A ECMO). The aim of the present study was to assess
the effects of an intra-aortic balloon pump (IABP) to overcome such a
hemodynamic shortcoming in patients submitted to peripheral V-A ECMO. Methods: Among 184 adult patients who were treated with peripheral V-A ECMO support at
Medical University Center Maastricht Hospital between 2007 and 2018,
patients submitted to IABP implant for protracted AV closure after V-A ECMO
implant were retrospectively identified. All clinical and hemodynamic data,
including echocardiographic monitoring, were collected and analyzed. Results: During the study period, 10 subjects (mean age 60 years old, 80% males)
underwent IABP implant after peripheral V-A ECMO positioning due to the
diagnosis of protracted AV closure and inefficient LV unloading as assessed
by echocardiography and an absence of pulsation in the arterial pressure
wave. Recovery of blood pressure pulsatility and enhanced LV unloading were
observed in 8 patients after IABP placement, with no significant differences
in the main hemodynamic parameters, inotropic therapy or in the ECMO flow
(p=0.48). The weaning rate in this patient subgroup (mean ECMO duration 8
days), however, was only 10%, with another patient finally transplanted,
leading to a 20% survival-to-hospital discharge. Conclusion: IABP placement was an effective solution in order to reverse the protracted
AV closure and impaired LV unloading observed during peripheral V-A ECMO
support. However, the impact on the weaning rate and survival needs further
investigations.
Collapse
Affiliation(s)
- Paolo Meani
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,2 Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Thijs Delnoij
- 2 Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,3 Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Giuseppe M Raffa
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,4 Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation and Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Nuccia Morici
- 5 De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy.,6 Department of Clinical Sciences and Community Health, Università degli Studi, Milan, Italy
| | - Giovanna Viola
- 5 De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Alice Sacco
- 5 De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Fabrizio Oliva
- 5 De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan, Italy
| | - Sam Heuts
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jan-Willem Sels
- 2 Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,3 Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Rob Driessen
- 2 Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,3 Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Paul Roekaerts
- 3 Intensive Care Unit, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Martijn Gilbers
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Elham Bidar
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Rick Schreurs
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Ehsan Natour
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Leo Veenstra
- 2 Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Suzanne Kats
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Jos Maessen
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Roberto Lorusso
- 1 Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| |
Collapse
|
7
|
Fair J, Tonna J, Ockerse P, Galovic B, Youngquist S, McKellar SH, Mallin M. Emergency physician–performed transesophageal echocardiography for extracorporeal life support vascular cannula placement. Am J Emerg Med 2016; 34:1637-9. [DOI: 10.1016/j.ajem.2016.06.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/04/2016] [Accepted: 06/04/2016] [Indexed: 12/26/2022] Open
|
8
|
Douflé G, Roscoe A, Billia F, Fan E. Echocardiography for adult patients supported with extracorporeal membrane oxygenation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:326. [PMID: 26428448 PMCID: PMC4591622 DOI: 10.1186/s13054-015-1042-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) support is increasingly being used in recent years in the adult population. Owing to the underlying disease precipitating severe respiratory or cardiac failure, echocardiography plays an important role in the management of these patients. Nevertheless, there are currently no guidelines on the use of echocardiography in the setting of ECMO support. This review describes the current state of application of echocardiography for patients supported with both VA and VV ECMO.
Collapse
Affiliation(s)
- Ghislaine Douflé
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, M5G 2N2, Canada. .,Extracorporeal Life Support (ECLS) Program, Toronto General Hospital, Toronto, ON, M5G 2N2, Canada.
| | - Andrew Roscoe
- Department of Anaesthesia & ICU, Papworth Hospital, Cambridge, CB23 3RE, UK
| | - Filio Billia
- Extracorporeal Life Support (ECLS) Program, Toronto General Hospital, Toronto, ON, M5G 2N2, Canada.,Peter Munk Cardiac Centre, University Health Network, Toronto, ON, M5G 2N2, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, M5G 2N2, Canada.,Extracorporeal Life Support (ECLS) Program, Toronto General Hospital, Toronto, ON, M5G 2N2, Canada
| |
Collapse
|
9
|
Victor K, Barrett NA, Gillon S, Gowland A, Meadows CIS, Ioannou N. CRITICAL CARE ECHO ROUNDS: Extracorporeal membrane oxygenation. Echo Res Pract 2015; 2:D1-D11. [PMID: 26693336 PMCID: PMC4676436 DOI: 10.1530/erp-14-0111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 12/17/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is an advanced form of organ support indicated in selected cases of severe cardiovascular and respiratory failure. Echocardiography is an invaluable diagnostic and monitoring tool in all aspects of ECMO support. The unique nature of ECMO, and its distinct effects upon cardio-respiratory physiology, requires the echocardiographer to have a sound understanding of the technology and its interaction with the patient. In this article, we introduce the key concepts underpinning commonly used modes of ECMO and discuss the role of echocardiography.
Collapse
Affiliation(s)
- Kelly Victor
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust , London , UK ; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Nicholas A Barrett
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Stuart Gillon
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Abigail Gowland
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust , London , UK ; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust , London , UK
| | | | - Nicholas Ioannou
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust , London , UK
| |
Collapse
|
10
|
Frequency of superior vena cava obstruction in pediatric heart transplant recipients and its relation to previous superior cavopulmonary anastomosis. Am J Cardiol 2013; 112:286-91. [PMID: 23587279 DOI: 10.1016/j.amjcard.2013.03.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/06/2013] [Accepted: 03/06/2013] [Indexed: 11/20/2022]
Abstract
The risk factors for superior vena cava (SVC) obstruction after pediatric orthotopic heart transplantation (OHT) have not been identified. This study tested the hypothesis that pretransplant superior cavopulmonary anastomosis (CPA) predisposes patients to SVC obstruction. A retrospective review of the Pediatric Cardiac Care Consortium registry from 1982 through 2007 was performed. Previous CPA, other cardiac surgeries, gender, age at transplantation, and weight at transplantation were assessed for the risk of developing SVC obstruction. Death, subsequent OHT, or reoperation involving the SVC were treated as competing risks. Of the 894 pediatric OHT patients identified, 3.1% (n = 28) developed SVC obstruction during median follow-up of 1.0 year (range: 0 to 19.5 years). Among patients who developed SVC obstruction, 32% (n = 9) had pretransplant CPA. SVC surgery before OHT was associated with posttransplant development of SVC obstruction (p <0.001) after adjustment for gender, age, and weight at OHT and year of OHT. Patients with previous CPA had increased risk for SVC obstruction compared with patients with no history of previous cardiac surgery (hazard ratio 10.6, 95% confidence interval: 3.5 to 31.7) and to patients with history of non-CPA cardiac surgery (hazard ratio 4.7, 95% confidence interval: 1.8 to 12.5). In conclusion, previous CPA is a significant risk factor for the development of post-heart transplant SVC obstruction.
Collapse
|
11
|
Endovascular therapy in extracorporeal membrane oxygenation survivors: sailing out into open water. Pediatr Crit Care Med 2013; 14:103-4. [PMID: 23295839 DOI: 10.1097/pcc.0b013e31825b826b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Obstruction of the superior vena cava after neonatal extracorporeal membrane oxygenation: association with chylothorax and outcome of transcatheter treatment. Pediatr Crit Care Med 2013; 14:37-43. [PMID: 23295835 DOI: 10.1097/pcc.0b013e31825b5270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obstruction of the superior vena cava is one of the potential complications of neonatal extracorporeal membrane oxygenation. Chylothorax is a known complication of surgery involving the thoracic cavity in children, and of extracorporeal membrane oxygenation. The aim of this study was to evaluate the association between chylothorax and superior vena cava obstruction after neonatal extracorporeal membrane oxygenation. METHODS AND RESULTS Twenty-two patients diagnosed with superior vena cava obstruction at ≤ 6 months of age (median 1.8 months) after neonatal extracorporeal membrane oxygenation were compared with a randomly selected cohort of 44 neonatal extracorporeal membrane oxygenation patients without superior vena cava obstruction. Among patients with superior vena cava obstruction, 18 underwent extracorporeal membrane oxygenation for respiratory disease and four for cardiac insufficiency. Chylothorax was more prevalent among patients with superior vena cava obstruction than controls (odds ratio 9.4 [2.2-40], p = .01) and was associated with extension of obstruction into the left innominate vein. Patients with superior vena cava obstruction were supported by extracorporeal membrane oxygenation for a longer duration than controls. Nineteen patients with superior vena cava obstruction (86%) underwent transcatheter balloon angioplasty and/or stent implantation (median 7 days after diagnosis), which decreased the superior vena cava pressure and superior vena cava-to-right atrium pressure gradient and increased the superior vena cava diameter (all p < 0.001). There were no serious procedural adverse events. Six study patients died within 30 days of the diagnosis of superior vena cava obstruction (including three of nine with chylothorax), which did not differ from controls. During a median follow-up of 2.7 yrs, two additional patients died and nine underwent 14 superior vena cava reinterventions. CONCLUSIONS Among neonates treated with extracorporeal membrane oxygenation, superior vena cava obstruction is associated with an increased risk of chylothorax. In neonates with chylothorax after extracorporeal membrane oxygenation, evaluation for superior vena cava obstruction may be warranted. Although mortality is high in this population, transcatheter treatment can relieve superior vena cava obstruction and facilitate symptomatic improvement.
Collapse
|
13
|
Agnoletti G, Marini D, Bordese R, Villar AM, Gabbarini F. Interventional catheterisation of stenotic or occluded systemic veins in children with or without congenital heart diseases: early results and intermediate follow-up. EUROINTERVENTION 2012; 7:1317-25. [PMID: 22433195 DOI: 10.4244/eijv7i11a207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Limited data exists on midterm results concerning paediatric interventions on stenotic or occluded systemic veins following indwelling lines, cardiac surgery, or catheterisations. The purpose of this study was to report our acute and intermediate results concerning patients with (Group A) and without (Group B) congenital heart diseases (CHD) over a 10-year period. METHODS AND RESULTS From January 2000 to December 2010, 32 patients (23 in Group A and nine in Group B, respectively) underwent 39 interventional catheterisations aimed to dilate or recanalise occluded iliofemoral veins, inferior or superior venae cavae. Initial and follow-up catheterisation data were reviewed retrospectively. Midterm results were evaluated by means of echography, angiography, and CT scan in all 15 and 17 patients, respectively. Median age and weight of all patients at catheterisation were five years (range 0.1-18) and 15 kg (range 2-60), respectively. Fifty-two stents were implanted in 29 patients (32 vessels). In 25 patients 28 vessels were occluded and required recanalisation. There were no major complications. In all but three patients it was possible to treat the lesion. There were two procedural complications (5.1%): one acute stent occlusion and one local dissection. At a median follow-up of 2.5 years (range 1-10) we observed six complications of stenting (11.5%): two fractures, two occlusions and two restenoses. CONCLUSIONS Interventional catheterisation of stenotic or occluded systemic veins grants good immediate results at a low rate of complication. Stent dilatation or recanalisation may open the vessel for use during future procedures. However, long-term results are yet to be established.
Collapse
Affiliation(s)
- Gabriella Agnoletti
- Department of Cardiology, Paediatric Hospital Regina Margherita, Turin, Italy.
| | | | | | | | | |
Collapse
|
14
|
Platts DG, Sedgwick JF, Burstow DJ, Mullany DV, Fraser JF. The Role of Echocardiography in the Management of Patients Supported by Extracorporeal Membrane Oxygenation. J Am Soc Echocardiogr 2012; 25:131-41. [DOI: 10.1016/j.echo.2011.11.009] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Indexed: 01/08/2023]
|
15
|
Frazer JR, Ing FF. Stenting of stenotic or occluded iliofemoral veins, superior and inferior vena cavae in children with congenital heart disease: Acute results and intermediate follow up. Catheter Cardiovasc Interv 2009; 73:181-8. [DOI: 10.1002/ccd.21790] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
16
|
|
17
|
Tzifa A, Marshall AC, McElhinney DB, Lock JE, Geggel RL. Endovascular Treatment for Superior Vena Cava Occlusion or Obstruction in a Pediatric and Young Adult Population. J Am Coll Cardiol 2007; 49:1003-9. [PMID: 17336725 DOI: 10.1016/j.jacc.2006.10.060] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 09/29/2006] [Accepted: 10/23/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this research was to investigate the causes and symptoms of superior vena cava (SVC) obstruction or occlusion and report on the long-term results of transcatheter therapy. BACKGROUND Information on transcatheter therapy for SVC obstruction is limited. METHODS Superior vena cava catheterization interventions between August 1984 and April 2006 were reviewed. Patients were divided into 2 subgroups depending on whether or not they had previously undergone congenital cardiac surgery. RESULTS Sixty-three patients with median age of 3.7 years (range 1 month to 42 years) and weight of 13.3 kg (range 3 to 114 kg) were treated. Fifty patients (79%) were symptomatic, although only 50% had symptoms suggestive of SVC obstruction. Superior vena cava syndrome was more common in the non-cardiac surgical group (52% vs. 10%, p = 0.001). The mean gradient and SVC diameter improved from 10.8 +/- 5.8 mm Hg to 2.6 +/- 2.2 mm Hg (p < 0.001) and 3.1 +/- 2.7 mm to 9.1 +/- 3.8 mm, respectively (p < 0.001). The obstruction was adequately relieved in all 36 patients receiving stents and in 21 of 27 patients (78%) who had balloon dilation alone. Complications occurred in 12 patients (19%), all of whom had previously undergone cardiac surgery; 10 of these patients were successfully treated in the catheterization laboratory. Freedom from re-intervention did not differ between patients undergoing balloon dilation or stent implantation, but was longer in patients age >5 years at the time of intervention. CONCLUSIONS Superior vena cava-related symptoms occur in only 50% of patients with hemodynamically significant SVC obstruction. Endovascular therapy is successful in relieving the stenosis and associated symptoms with good long-term results.
Collapse
Affiliation(s)
- Aphrodite Tzifa
- Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | | | | | | | | |
Collapse
|
18
|
Yuen S, Linney MJ, John P, Berry K. Superior vena cava obstruction in an 8-month-old infant. Pediatr Emerg Care 2003; 19:91-4. [PMID: 12698033 DOI: 10.1097/00006565-200304000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Abstract
There has been an evolution in vascular access in the neonate. Newer types of materials and catheters, such as PICC lines and ECMO catheters, are now available. The frequency of line placement has increased, and radiologists now perform many of these procedures. This places the radiologist in the position of not only diagnosing complications, but actually causing them. Knowledge of these complications can help the practitioner avoid them and diagnose them as quickly as possible when they occur.
Collapse
Affiliation(s)
- M J Hogan
- Department of Radiology, Columbus Children's Hospital, Ohio, USA
| |
Collapse
|
20
|
Becker JA, Short BL, Martin GR. Cardiovascular complications adversely affect survival during extracorporeal membrane oxygenation. Crit Care Med 1998; 26:1582-6. [PMID: 9751597 DOI: 10.1097/00003246-199809000-00030] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Extracorporeal membrane oxygenation (ECMO) has been used in the management of infants with cardiorespiratory failure. ECMO causes a decrease in load-dependent measures of cardiac performance that have not been demonstrated to affect patient outcome, while other cardiovascular complications occur which may affect outcome. The purpose of this study was to describe the cardiovascular complications associated with ECMO, and to determine their relationship to survival. DESIGN Data were obtained, retrospectively, from the medical records of 500 consecutive newborns treated with ECMO at our institution since 1984. RESULTS Hypertension (mean arterial pressure of >65 mm Hg) was the most common complication, requiring medical intervention in 192 infants. Myocardial stun, the near-total absence of systolic function during ECMO, occurred in 59 infants. Rhythm abnormalities, including noncannulation-related bradycardia, occurred in 43 infants, cardiac arrest, and pericardial effusion in 17 infants, and noninfective thrombosis in 9 infants. Only one infant required ligation of a patent ductus arteriosus during ECMO. Infants with at least one cardiovascular complication had a lower survival rate, compared with those infants without a complication. Survival rates were decreased in infants with myocardial stun, arrhythmia, and cardiac arrest. Hypertension and pericardial effusion were not associated with decreased survival. CONCLUSION These findings suggest that some cardiovascular complications during ECMO are more common than previously thought, and cardiovascular complications may adversely impact outcome.
Collapse
Affiliation(s)
- J A Becker
- Department of Cardiology, Children's National Medical Center, Washington, DC 20010, USA
| | | | | |
Collapse
|
21
|
Affiliation(s)
- J Petäjä
- Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA, USA
| | | |
Collapse
|
22
|
van der Staak FH, de Haan AF, Geven WB, Festen C. Surgical repair of congenital diaphragmatic hernia during extracorporeal membrane oxygenation: hemorrhagic complications and the effect of tranexamic acid. J Pediatr Surg 1997; 32:594-9. [PMID: 9126762 DOI: 10.1016/s0022-3468(97)90715-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) was incorporated in a strategy of delayed repair of congenital diaphragmatic hernia (CDH) and was used for preoperative stabilization in patients who were unresponsive to maximal conventional treatment. If ECMO was required for preoperative stabilization the diaphragmatic defect was repaired while the patient was on ECMO. In the early experience with this approach all patients suffered from bleeding complications. Therefore, we adopted the use of antifibrinolytic therapy with tranexamic acid (TEA) during and immediately after CDH repair on ECMO. The efficacy of TEA was studied in an unblinded study using historical controls by comparing the postoperative blood loss and the transfusion requirements of red blood cells (RBC) in patient groups treated without (n = 9) and with TEA (n = 10). Patients who received TEA had significantly less bleeding at the surgical site than patients not receiving TEA (57 v 390 mL, P = .005) and had significantly lower RBC transfusion requirements than patients not receiving TEA (1.13 v 2.95 mL/kg/h, P = .03). In the very first two patients of the TEA group we encountered fairly severe thrombotic complications. TEA may have contributed to those complications. Based on the authors' experience they conclude: (1) TEA is effective in reducing postoperative blood loss, hemorrhagic complications, and RBC transfusion requirements associated with CDH repair on ECMO. (2) TEA may be responsible for thrombotic complications. (3) The appropriate, empirically established, dosage and administration patterns of TEA for CDH repair during ECMO seem to be one bolus of 4 mg/kg TEA intravenously 30 minutes before the anticipated CDH repair and a continuous infusion of 1 mg/kg/h TEA during the 24 hours after CDH repair.
Collapse
Affiliation(s)
- F H van der Staak
- Department of Pediatric Surgery, Faculty of Medical Sciences, University of Nijmegen, The Netherlands
| | | | | | | |
Collapse
|