title: Evaluation of different types of inferior vena cava cannulae placement by transesophageal echocardiography and its impact on hepatic dysfunction.
abstract: Postoperative hepatic dysfunction may occur in an otherwise uncomplicated open heart surgery. One of the reasons is malpositioning of the inferior vena cava (IVC) cannula in the hepatic vein (HV) or beyond. A straight cannula is considered more likely to be malpositioned compared to the angled cannula and a malpositioned cannula can lead to hepatic dysfunction.
  
  
  
  In this prospective study, forty adult patients undergoing atrial septal defect repair were randomized into two groups as: straight cannula group (n=20) and angled cannula group (n=20). The cannula position was assessed by transesophageal echocardiography (TEE) (hepatic vein view). Alanine aminotransferase levels (ALT) and bilirubin levels were measured immediately, at 6 hours and on day 1, day 2 and day 7 after surgery as a marker of hepatic injury.
  
  
  
  TEE localization of the IVC cannula was achieved in all patients except one. Visualization was good in 85% of patients. A cannula in the HV or beyond the HV in the IVC was considered malpositioned. The number of cases of cannula malposition was 10 (50%) and 4 (20%) in the straight and angled cannula groups, respectively. The pattern of change in serum bilirubin and liver enzymes levels in the postoperative period was similar in both the groups (p>0.05). The mean distance between the right atrium (RA) - inferior vena cava (IVC) junction to the hepatic vein was 1.94±0.56 cm and the mean diameters of the IVC and HV were 1.95±0.5 and 1.31±0.33 cm, respectively.
  
  
  
  TEE can be used to monitor IVC cannula position. A higher frequency of cannula malposition was observed with the straight cannula compared to the angled cannula, but was not found to be associated with hepatic dysfunction.
authors.affiliation: Departments of Anaesthesiology and Intensive Care, G B Pant Hospital, New Delhi, India tempedeepak@hotmail.com.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Tempe
authors.affiliation: Departments of Anaesthesiology and Intensive Care, G B Pant Hospital, New Delhi, India.
authors.forename: Kiran L
authors.initials: KL
authors.lastname: Kiro
authors.affiliation: Cardiothoracic and Vascular Surgery, G B Pant Hospital, New Delhi, India.
authors.forename: Subodh
authors.initials: S
authors.lastname: Satyarthy
authors.affiliation: Departments of Anaesthesiology and Intensive Care, G B Pant Hospital, New Delhi, India.
authors.forename: Sanjula
authors.initials: S
authors.lastname: Virmani
authors.affiliation: Departments of Anaesthesiology and Intensive Care, G B Pant Hospital, New Delhi, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Cardiothoracic and Vascular Surgery, G B Pant Hospital, New Delhi, India.
authors.forename: Vithalkumar M
authors.initials: VM
authors.lastname: Betigiri
authors.affiliation: Cardiothoracic and Vascular Surgery, G B Pant Hospital, New Delhi, India.
authors.forename: Harpreet S
authors.initials: HS
authors.lastname: Minhas
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
chemical_list: D000410:Alanine Transaminase; D001663:Bilirubin
keywords: cannula position; hepatic vein cannulation; hepatic venous drainage; inferior vena cava cannula malposition; postoperative liver dysfunction in cardiac surgery; transesophageal echocardiography