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European Journal of Echocardiography Advance Access originally published online on May 1, 2008
European Journal of Echocardiography 2008 9(4):589-590; doi:10.1093/ejechocard/jen116
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

External compression of superior vena cava after the replacement of ascending aorta

Johannes Wacker, George Djaiani, Rita Katznelson* and Jacek Karski

Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4

Received 17 September 2007; accepted after revision 9 February 2008; online publish-ahead-of-print 1 May 2008.

* Corresponding author. Tel: +1 416 439 4800, ext 2840; fax: +1 416 340 3698. E-mail address: rita.katznelson{at}uhn.on.ca


  Abstract

We present a rare complication after open-heart surgery resulting in compression of the superior vena cava (SVC) with the concurrent findings of the hypertrophic obstructive cardiomyopathy physiology. A 59-year-old woman developed a low cardiac output syndrome, persistent hypotension, and increasing filling pressures after emergency replacement of the ascending aorta and resuspension of the aortic valve due to a type A aortic dissection. Transesophageal echocardiography (TEE) evaluation revealed partial SVC obstruction, under-filled left ventricle (LV), and a persistent mitral systolic anterior motion with increasing pressure gradient in the left ventricular outflow tract (LVOT). Surgical exposure uncovered an intrapericardial thrombus around the aortic graft compressing the SVC. Removal of the thrombus resulted in immediate haemodynamic improvement and elimination of both SVC and LVOT obstructions. A comprehensive TEE exam should always be performed, and all the structures should be visualized for the proper diagnosis and management of patients after cardiac surgery.

Keywords: SVC obstruction; HOCM


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