After a young mother gave birth to a set of twins, one of them began to suffer from congenital defects including severely obstructed cardiac blood flow, thickened tricuspid valves, and dilated heart chambers. The child was transferred to a specialized Children’s Hospital due to significant hypertension. Three days following her birth, she underwent cardiac catheterization and attempts to widen her arteries and facilitate blood flow, after which she suffered episodes of hypoxia overnight and was discovered to have decreased circulation from her hips to her toes, which appeared mottled and swollen. Procedures to remedy this through the ductus arteriosus blood vessel had to be aborted, and the infant’s left foot began to appear pale and lose any sign of a pulse. She was diagnosed with thrombosis and decreased velocity and flow dysfunction in her femoral and popliteal arteries, and required an amputation at her hip. During the trial against the child’s doctors, the perspective of a pediatric interventional cardiologist was sought to opine on whether the alleged complications encountered while surgeons tried to insert a widening stent into the ductus fell below the standard of care.
Question(s) For Expert Witness
- 1. Do you routinely manage pediatric patients, particularly those suffering from such advanced cardiac anomalies?
- 2. Have you reviewed a case with similar outcomes from a catheterization for a ductus arteriosus?
- 3. Have you ever lectured, trained other clinicians or published on this subject matter?
Expert Witness Response E-004998
I have extensive experience with cardiac catheterization in neonates, children, and adults who have congenital heart disease. Though I have reviewed cases with vascular injury related to cardiac catheterization, I’ve not reviewed a case with this outcome in a patient undergoing cardiac catheterization for closure or stenting of an arterial duct. I have several publications in the field of cardiac catheterization for simple and complex congenital heart disease, and have both trained other physicians and presented at national and international-level meetings.
Expert Witness Response E-043892
I routinely manage pediatric patients that are suffering from cardiac anomalies, and have reviewed a case with similar outcomes from a catheterization for a ductus arteriosus. I have also published on this subject. Typically, the decision to proceed with ductal stenting post successful pulmonary valve perforation is dependent on numerous factors. The vascular approach would likely be performed transvenously since a femoral artery approach in a small neonate carries an increased risk for vascular compromise.