Young Child is Permanently Disabled Following Cardiac Surgery

Case Overview

This case involves a 10-year-old female patient with Down syndrome that underwent a surgical procedure to repair a hole between her heart chambers and regulate her blood flow. She underwent a subsequent open-heart procedure to remove scar tissue from a stenotic mitral valve. During the surgery, she required intravenous cannulation via the groin with the arterial cannula in the femoral artery. After the surgery was completed, her leg appeared purple, cold, and swollen. After a few hours of observation, the color returned to the leg, but the pain continued to increase. Ultrasounds showed poor circulation to the superficial femoral and popliteal artery. Vascular surgery was consulted and diagnosed the patient with compartment syndrome. Vascular surgery performed a thromboembolectomy to remove the blood clot. However, it was felt to be too late to surgically remove the connective tissue to relieve the pressure, as the muscle damage had already occurred. The patient was left with permanent deformity, scarring, and disability and required ongoing therapy.

Questions to the Cardiothoracic Surgery expert and their responses

Please describe your background in cardiac surgery.

I am a congenital cardiac surgeon and very frequently perform re-operative surgery. Occasionally, these patients require femoral arterial and/or venous cannulation to establish cardiopulmonary bypass. I often will sew a graft to the artery to avoid distal limb ischemia.

What are possible complications following a groin cannulation in these patients?

Possible complications following groin cannulation include lower extremity ischemia, including compartment syndrome, loss of limb, venous congestion, lymphocele, and nerve damage. Suspicion of limb ischemia should be prompted by loss of sensory or motor function, pain, loss of doppler signal.

What tests should be obtained?

Tests to order include arterial doppler study and angiography. Vascular consults should be obtained rapidly as tissue damage can occur as soon as 4-6 hours from onset of symptoms.

About the expert

This expert has nearly 15 years of experience in the field of cardiothoracic surgery. He earned his BA in biology from Cornell University and his MD from New York University School of Medicine, where he completed his residency in general surgery. He then went on to complete a fellowship in thoracic surgery at the University of Colorado Health Sciences Center, a fellowship in pediatric cardiac surgery at the University of California, San Francisco, and a fellowship in congenital cardiac surgery at Stanford University. He is active in his field as a member of numerous medical societies, including the Western Thoracic Surgical Association, the Society of Thoracic Surgeons, and the Council on Cardiovascular Surgery and Anesthesia. In addition, he has published over 25 journal articles and book chapters. Formerly, he was an attending congenital cardiac surgeon at the University of Florida, where he was also an assistant professor in the department of surgery and pediatrics, an assistant professor of cardiothoracic surgery at New York University, the director of pediatric and adult congenital cardiac surgery at the Children's Hospital of New Jersey, and an attending physician at NYU Langone and Bellevue Hospital. Currently, he serves as the director of congenital cardiac surgery at a medical center in Maine and is an associate professor of surgery at a medical school in Massachusetts.

E-006996

Specialties:

Cardiothoracic Surgery

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