title: Right ventricular rupture and tamponade caused by malposition of the Avalon cannula for venovenous extracorporeal membrane oxygenation.
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.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, PA, USA. Hitoshi.Hirose@jefferson.edu
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirose
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamane
authors.forename: Gregary
authors.initials: G
authors.lastname: Marhefka
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cavarocchi
mesh_terms: D002305:Cardiac Tamponade / Q000209:etiology*; D057785:Catheters / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006335:Heart Injuries / Q000209:etiology* / Q000601:surgery; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D008875:Middle Aged; D012131:Respiratory Insufficiency