Published: 2022-06-27

Recurrent cardiac arrests due to severe aortic flow obstruction by aortic cannula: a fatal complication

Vishnu Datt, Suman Keshav, Rachna Wadhwa, Shradha Malik, Ehtesham Naqvi, Saket Aggarwal


In neonates and children the blood vessels are small in calibre and the correct choice of arterial and venous cannulas together with accurate placement are crucial to avoid obstructing vascular branches and misdirecting flow or impairing venous drainage. Normally in children, to establish the cardiopulmonary bypass (CPB) one arterial cannula is inserted in the ascending aorta and single stage venous cannulae, where two cannulae inserted into the superior and inferior vena cava and joined by the Y-piece are used in the most open-heart surgeries to facilitate the circulatory, respiratory support along with the temperature management. Rarely aortic cannulation can lead to aortic dissection, aortic posterior wall rupture leading to trauma to the esophagus, dislodgement of the aortic atheroma, fatal bleeding leading even to cardiac arrest. In addition, SVC and IVC syndrome can also occur due to displacement or obstruction by the venous cannulae. However, repeated episodes of the cardiac arrests in children after successful weaning from CPB, even with the use of an appropriate size aortic cannula has not been reported in the literature to date. We wished to discuss this fatal complication after weaning from CPB, due to aortic flow obstruction by the aortic cannula in a one-year-old, 5.5 kg child following successful ventricular septal defect (VSD) repair. The institutional ethical committee clearance and clinical trial registrations are not applicable for this case report publication.


Congenital heart disease, CPB, Aortic cannulation, Aortic obstruction, Cardiac arrest, TEE

Full Text:



Straka C, Ying J, Kong F, Willey CD, Kaminski J, Kim DWN. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. Springerplus. 2016;5:229.

Gargava A, Sarkar M, Umbarkar S, Shringarpure A. Aortic cannula tip dislodgement: A rare complication. Ann Card Anaesth. 2020;23(4):515-7.

Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW. American heart association council on epidemiology and prevention statistics committee and stroke statistics subcommittee. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):56-528.

Kouchoukos N, Blackstone E, Doty D, Hanley F, Karp R. Cardiac surgery. WB Saunders; 2003: 107-18.

Bond E, Valadon C, Slaughter M. Cannulation for cardiopulmonary bypass. Cardiac Surgery Procedures. IntechOpen; 2019.

Hessel EA, Hill AG. Circuitry and cannulation techniques. In: Gravlee GP, Davis RF, Kursz M, Utley JR, eds. Cardiopulmonary Bypass: Principles and Practice. 2nd ed. Philadelphia, PA: LWW; 2000.

Kincaid EH, Hammon JW. Cardiopulmonary bypass. In: Yuh DD, Vricella LA, Yang SC, Doty JR, eds. Johns Hopkins Textbook of Cardiothoracic Surgery. 2nd ed. New York, NY: McGraw-Hill; 2014.

Sarkar M, Prabhu V. Basics of cardiopulmonary bypass. Indian J Anaesth. 2017;61(9):760-7.

Magner JB. Complications of aortic cannulation for open-heart surgery J. Thorax. 1971;26:172-3.