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.
Question(s) For Expert Witness
- 1. Please describe your background in cardiac surgery.
- 2. What are possible complications following a groin cannulation in these patients?
- 3. What tests should be obtained?
Expert Witness Response E-006996
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. 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. 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.