SVC_Obstruction_---_vishal baldua

SVC Obstruction --- vishal : 

SVC Obstruction --- vishal Vishal baldua , Mumbai , India

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8 yr old boy presented with acute onset breathlessness O/E had markedly decreased bilateral air entry with bilateral wheeze Saturations ----- 67 on Non rebreathing mask Intubated immediately --- improved air entry thereafter

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XRC showed bilateral hyperinflation with mediastinal widening ?? SVC syndrome due to mediastinal mass

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Initial blood gas showed severe mixed acidosis with lactates of 14 Noted to have rapidly progressing swelling on the face and bulging eyeballs--- s/o increasing SVC congestion due to increased flow No postural changes in respiratory or hemodynamic status Child died within the next 15 minutes

? Cause of death : 

? Cause of death Severe cerebral congestion leading to coning With add on instability due to decreased LV output

Probable solution : 

Probable solution If we use the central line set-up – the IJV -- CVL would reach the RA & bypass the obstruction and blood flow would be that from the IVC

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Rather , if we leave the shorter single lumen dilator in ---- we would be able to decompress the SVC with good flows . The Blood can then be routed by a simple iv line tubing to the femoral vein that would serve as decompression of SVC . The complete cardiac output would be maintained by IVC inflow --- which is now the entire systemic venous return

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To avoid clot formation , a low dose heparin infusion can be added as a side port to the decompressing iv tubing . The venous pressure gradient will drive the flows till equilibriation . By doing cerebral cooling and Phenobarb, we may decrease the cerebral inflow to further decrease the SVC outflow from the HFN area .

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In the meantime , efforts can be made to mobilise the OR for an open sternotomy decompression of the mediastinum

Slide 11: 

Thank you ---- Inputs and comments are most welcome