Acute renal failure in an infant attributable to arterial cannula malposition during cardiopulmonary bypass via ministernotomy

Junko Murakami, Ken Yamaura, Takashi Akata, Shosuke Takahashi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

A 6-month-old female (4.9 kg) with multiple congenital heart lesions underwent intracardiac repair with the aid of cardiopulmonary bypass (CPB) through a lower half sternotomy. Aortic cannulation, venous cannulation, and cardioplegia cannula insertion were all accomplished through the ministernotomy. During the CPB, in spite of a high perfusion flow rate (182 ml · kg -1 · min -1 ), the systemic arterial pressure was persistently low (mean values = 25-35 mmHg) and the urine output was greatly reduced (<ml · hr -1 ). In addition, inappropriate increases in the arterial inflow line pressure were recognized. Since abutment of the cannula tip against the aortic intima was suspected, several attempts were made to correct its malpositioning. During the CPB, hemolysis was also found in the mixed venous blood. Since the oliguria and resultant hyperkalemia persisted after weaning from the CPB, peritoneal dialysis was introduced immediately after the surgery. Her renal function gradually recovered postoperatively, and she was finally weaned from the peritoneal dialysis on the 13 th postoperative day. Although the ministernotomy has been proposed to be a safe approach for most of cardiac surgeries, it appears to increase the risk for arterial cannula malposition as compared to the standard full-length sternotomy in small pediatric patients.

Original languageEnglish
Pages (from-to)264-269
Number of pages6
JournalJapanese Journal of Anesthesiology
Volume51
Issue number3
Publication statusPublished - Apr 22 2002

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

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