Document Detail

A case of Takayasu arteritis complicated by right atrium perforation and injuries of the right common iliac artery and vein caused by cannulation for percutaneous cardiopulmonary support.
MedLine Citation:
PMID:  19949317     Owner:  NLM     Status:  MEDLINE    
We describe an autopsy case of Takayasu arteritis with right atrium perforation and injuries of the right common iliac artery and vein caused by cannulation for percutaneous cardiopulmonary support (PCPS). The decedent was an 8-year-old girl admitted for examination in respect to chest pain and syncope. During catheter angiography, she suddenly went into cardiac arrest. PCPS was attempted, whereupon bleeding into the abdominal cavity and an injury to the common iliac vein were observed. She was pronounced dead 78 hours after the initiation of PCPS. Autopsy revealed thickening of the aortic wall from the ascending aorta to the abdominal aorta, with narrowing of the proximal branches. Hemopericardium induced by right atrium perforation, and an injury of the right common iliac artery, were also found. Microscopic examinations of the aorta disclosed thickening of each layer of the vessel wall and inflammatory cell infiltration, mainly into the outer layer of the media. It was speculated that manipulation of the catheter and the underlying Takayasu arteritis caused cardiac arrest. It is also considered that hypovolemia was induced by the injuries of the right common iliac artery and vein caused during the insertion of the PCPS venous cannula. In addition, the right atrium was injured by the edge of the PCPS cannula, leading to hemopericardium. In pediatric cases involving PCPS, or in cases where cannulation is difficult, regular examination of the pericardial and abdominal cavities by echocardiography would provide useful information to prevent such accidents.
Masataka Takamiya; Sachiko Fujita; Hisae Niitsu; Yasuhiro Aoki; Hiroyuki Kanno; Takashi Sawai
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The American journal of forensic medicine and pathology     Volume:  31     ISSN:  1533-404X     ISO Abbreviation:  Am J Forensic Med Pathol     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-24     Completed Date:  2010-06-10     Revised Date:  2011-02-02    
Medline Journal Info:
Nlm Unique ID:  8108948     Medline TA:  Am J Forensic Med Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  72-6     Citation Subset:  IM    
Department of Legal Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.
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MeSH Terms
Cardiopulmonary Bypass / adverse effects*,  instrumentation
Coronary Vessels / pathology
Forensic Pathology
Heart Atria / injuries*,  pathology
Iliac Artery / injuries*,  pathology
Iliac Vein / injuries*,  pathology
Intra-Aortic Balloon Pumping
Lung / pathology
Pericardial Effusion / pathology
Pulmonary Edema / pathology
Takayasu Arteritis / pathology*
Wounds, Penetrating / etiology,  pathology*

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