Obstruction of the Superior Vena Cava After Neonatal Extracorporeal Membrane Oxygenation

Abstract

Among neonates treated with extracorporeal membrane oxygenation, superior vena cava obstruction is associated with an increased risk of chylothorax. In neonates with chylothorax after extracorporeal membrane oxygenation, evaluation for superior vena cava obstruction may be warranted. Although mortality is high in this population, transcatheter treatment can relieve superior vena cava obstruction and facilitate symptomatic improvement.

Intravascular Stent Implantation as Effective Therapy for Refractory Chylothorax Secondary to Congenital Superior Vena Cava Stenosis in an Infant

“…The most common site for this type of obstruction is the innominate vein [6], but as demonstrated in this case, the SVC are acquired rather than congenital. The three most common etiologies are thrombosis surrounding a port or central line, external compression from tumors or other mass effect, and surgical complications including direct injury of the thoracic duct or postoperative stenosis of the SVC or innominate vein [4,7,8,9,10]. Congenital-rather than acquired-SVC stenosis as presented in our case is exceedingly rare and thus far has only been reported in the presence of other significant cardiac anomalies.…”

Pediatric superior vena cava syndrome: An evidence‐based systematic review of the literature

“…CVC, central venous catheter; SVCS, superior vena cava syndrome; RF, risk factors 1 Percentages represent proportions of the total number of cases . Percentages represent proportions of oncological cases . Percentages represent proportions of cardiac cases .…”

“…Specifically, SVCS was associated with a longer duration on ECMO and was strongly associated with the development of chylothorax (OR: 9.4; 95% CI: 2.2–40, P = 0.01), resulting in higher associated mortality in the SVCS group (36%) versus controls (30%). Eighty‐eight percent of the cases resolved using balloon dilation with or without stent placement, with no serious adverse events from the intervention …”

“…Due to the relative rarity of this syndrome in children, there are few retrospective cohort studies available, most examining single subtypes of SVCS . In addition, these studies commonly include both children and adults, making it difficult to reach conclusions relevant to the pediatric population .…”

Balloon Angioplasty for the Treatment of Left Innominate Vein Obstruction Related Chylothorax after Congenital Heart Surgery

“…Postoperative chylous effusion management algorithms aimed at identifying deep venous thrombosis (DVT) have been reported; and treatment with heparinization, local/systemic thrombolytics, and thrombectomy have been utilized if DVT is identified . Sparse reports have highlighted the potential benefits of innominate vein and superior vena cava angioplasty to ameliorate chylous effusions after pacemaker implantation and extracorporeal membrane oxygenation . However, there are no data on the utility of angioplasty for left innominate vein obstruction‐associated chylothorax in children and neonates following congenital heart surgery.…”