Perforation of the superior vena cava during ECMO catheterization in two neonates with congenital diaphragmatic hernia: a cause of accidental death

The American Journal of Forensic Medicine and Pathology
Jessica B BareBahig M Shehata

Abstract

Congenital diaphragmatic hernia (CDH) is a defect seen in approximately 1 in 3500 live births. A complication of CDH is the herniation of abdominal contents into the chest cavity through the defect, which may prevent normal intrauterine development of the lungs. The resultant pulmonary hypoplasia and pulmonary hypertension causes respiratory distress in the newborn, usually requiring some form of intervention before the defect is surgically corrected (Embryology for Surgeons. Baltimore, MD: Williams & Wilkins; 1994:491-539). Extracorporeal membrane oxygenation, which involves cannulation of the superior vena cava (SVC), is often used to manage these infants. However, the mediastinal shift that often occurs with CDH can cause an abnormal acute angulation of the SVC, which during cannulation can result in trauma and possible perforation of the SVC. We present 2 autopsy cases where the infants accidentally died as a result of extracorporeal membrane oxygenation cannulation.

References

Dec 30, 1998·Journal of Pediatric Surgery·K C van Engelenburg, C Festen
May 3, 2002·Journal of Pediatric Surgery·Keith A KuenzlerStephen G Murphy
Mar 17, 2005·Seminars in Pediatric Surgery·Karen P Harrington, Alan P Goldman
Jun 1, 2005·Seminars in Perinatology·Patricia RothenbachDavid Powell

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Citations

Mar 12, 2016·Emergency Radiology·Aftab A HaqDaniel Vargas
Apr 3, 2021·Journal of Perinatology : Official Journal of the California Perinatal Association·Thomas W PawlowskiMaría V Fraga
Jul 12, 2011·Critical Care Clinics·Pauline K ParkRobert H Bartlett

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