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      Cannula Positioning in an Infant on Venoarterial Extracorporeal Membrane Oxygenation: A Rare Cause of Reverse Differential Cyanosis

      case-report

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          Graphical abstract

          Highlights

          • •

            Reverse differential cyanosis in patients on VA-ECMO via carotid cannulation is very rare.

          • •

            A malpositioned aortic cannula can cause cerebral perfusion with deoxygenated blood.

          • •

            Checking oxygen saturations in the lower extremity alone can be falsely reassuring.

          • •

            Document simultaneous upper and lower extremity saturations for all patients on VA-ECMO.

          • •

            Echo is a useful diagnostic tool to confirm cannula position and guide adjustment.

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          Reversed differential cyanosis in the newborn: a clinical finding in the supracardiac total anomalous pulmonary venous connection.

          Shook Yap, Nicole Anania, Ernerio Alboliras … (2009)
          The newborn can experience two types of differential cyanosis (DC). The common type of DC occurs when oxygen saturation in the right hand is greater than in the foot. The second type of DC, reversed differential cyanosis (RDC), occurs when oxygen saturation is lower in the right hand than in the foot. This phenomenon is observed in transposition of the great arteries (TGA) with patent ductus arteriosis (PDA) and elevated pulmonary vascular resistance or in TGA with PDA and preductal aortic interruption or coarctation. This report describes a case of RDC not previously described involving an infant with supracardiac total anomalous pulmonary venous connection (TAPVC). In supracardiac TAPVC, RDC results from streaming of highly saturated superior vena cava (SVC) blood into the right ventricle, out the main pulmonary artery, through a PDA, and to the descending aorta, with streaming of more desaturated blood from the inferior vena cava (IVC) into the left atrium across the atrial septal defect (ASD)/foramen ovale. Therefore, as part of a neonatal examination to rule out congenital heart disease (CHD), simultaneous pre- and postductal oxygen saturations should be documented. The presence of RDC should initiate immediate full cardiac evaluation for CHD. Supracardiac TAPVC should be included in the differential diagnosis if RDC is observed.
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            Reverse differential cyanosis: a treatable newborn cardiac emergency

            T.C. Martin, TC Martin (2011)
            Article 0 comments Cited 2 times – based on 0 reviews     Review now
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              Author and article information

              Contributors
              Ramya Ramachandra
              Journal
              Journal ID (nlm-ta): CASE (Phila)
              Journal ID (iso-abbrev): CASE (Phila)
              Title: CASE : Cardiovascular Imaging Case Reports
              Publisher: Elsevier
              ISSN (Electronic): 2468-6441
              Publication date PMC-release: 18 November 2023
              Publication date Collection: January 2024
              Publication date (Electronic): 18 November 2023
              Volume: 8
              Issue: 1
              Pages: 21-24
              Affiliations
              [a ]Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
              [b ]Division of Pediatrics, Stanford University School of Medicine, Stanford, California
              [c ]Pediatric Critical Care, Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
              Author notes
              [∗ ]Correspondence: Ramya Ramachandra, MD, Pediatric Cardiology Fellow, Stanford University School of Medicine, 725 Welch Road, Palo Alto, CA 94304. ramya215@ 123456stanford.edu
              Article
              Publisher Item ID: S2468-6441(23)00189-5
              DOI: 10.1016/j.case.2023.09.006
              PMC ID: 10801703
              SO-VID: fb321d54-17cc-4ec5-b317-ea574cb9eff5
              Copyright © 2023 by the American Society of Echocardiography. Published by Elsevier Inc.
              License:

              This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

              History
              Categories
              Subject: Congenital Heart Disease
              Subject: Never Too Young or Too Old to be Diagnosed with Congenital Heart Disease

              Keywords: reverse differential cyanosis,ecmo,cannula positioning
              Data availability:
              Keywords: reverse differential cyanosis, ecmo, cannula positioning

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