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Case Reports
. 2012 Apr 20:7:36.
doi: 10.1186/1749-8090-7-36.

Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

Hitoshi Hirose  1 , Kentaro Yamane, Gregary Marhefka, Nicholas Cavarocchi
Affiliations
Case Reports

Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation

Hitoshi Hirose et al. J Cardiothorac Surg. .

Abstract

Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO) via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for early identification of potential complications.

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Figures

Figure 1
Figure 1
Illustration of Avalon Elite bicaval dual lumen cannula in correct position.
Figure 2
Figure 2
Illustration of the right ventricular injury by Avalon cannula and echocardiography evidence of pericardial tamponade. LV: left ventricle. RV: right ventricle.
See this image and copyright information in PMC

References

    1. Bermudez CA, Rocha RV, Sappington PL, Toyoda Y, Murray HN, Boujoukos AJ. Initial experience with single cannulation for venovenous extracorporeal oxygenation in adults. Ann Thorac Surg. 2010;90:991–995. doi: 10.1016/j.athoracsur.2010.06.017. - DOI - PubMed
    1. Javidfar J, Brodie D, Wang D. et al.Use of bicavaldual-lumencatheter for adult venovenous extracorporeal membrane oxygenation. Ann Thorac Surg. 2011;91:1763–1768. doi: 10.1016/j.athoracsur.2011.03.002. - DOI - PubMed

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