Hemopericardium from coronary artery laceration complicating extracorporeal membrane oxygenation.
OBJECTIVE
We report the clinical course and successful surgical treatment of hemopericardium resulting from coronary artery (CA) laceration in two patients with congenital diaphragmatic hernia (CDH) undergoing extracorporeal membrane oxygenation (ECMO) bypass.


METHODS
Retrospective case review.


RESULTS
Two neonates with CDH had needle aspiration for either pneumothorax or pericardial effusion before initiation of ECMO. While on bypass, progressive hemopericardium led to narrow pulse pressure and decreased venous return that limited bypass flow. Widened cardiac silhouette on chest radiographs suggested hemopericardium; echocardiography was confirmatory in one case. The underlying diagnosis of CA laceration was made during pericardiotomy and treated with surgical patching.


CONCLUSIONS
Pre-ECMO history of cardiothoracic needle aspiration is important because complications such as hemothorax or hemopericardium may arise once ECMO bypass is initiated. Inadvertent CA laceration may lead to acute hemopericardium, compromising venous drainage. However, CA laceration can be successfully repaired while the patient is on bypass.
Rhine
W D
WD
Department of Pediatrics, Stanford University Medical Center, Palo Alto, CA, USA.
Hartman
G E
GE
Shochat
S J
SJ
Benitz
W E
WE
Van Meurs
K P
KP
D003331:Coronary Vessels / Q000293:injuries*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006548:Hernia, Diaphragmatic / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies