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A Case of Takayasu Arteritis Complicated by Right Atrium Perforation and Injuries of the Right Common Iliac Artery and Vein Caused by Cannulation for Percutaneous Cardiopulmonary Support

Takamiya, Masataka MD, PhD*; Fujita, Sachiko BS*; Niitsu, Hisae PhD*; Aoki, Yasuhiro MD, PhD*; Kanno, Hiroyuki MD, PhD†; Sawai, Takashi MD, PhD†

American Journal of Forensic Medicine & Pathology: March 2010 - Volume 31 - Issue 1 - pp 72-76
doi: 10.1097/PAF.0b013e3181c17dc6
Case Report

We describe an autopsy case of Takayasu arteritis with right atrium perforation and injuries of the right common iliac artery and vein caused by cannulation for percutaneous cardiopulmonary support (PCPS). The decedent was an 8-year-old girl admitted for examination in respect to chest pain and syncope. During catheter angiography, she suddenly went into cardiac arrest. PCPS was attempted, whereupon bleeding into the abdominal cavity and an injury to the common iliac vein were observed. She was pronounced dead 78 hours after the initiation of PCPS. Autopsy revealed thickening of the aortic wall from the ascending aorta to the abdominal aorta, with narrowing of the proximal branches. Hemopericardium induced by right atrium perforation, and an injury of the right common iliac artery, were also found. Microscopic examinations of the aorta disclosed thickening of each layer of the vessel wall and inflammatory cell infiltration, mainly into the outer layer of the media. It was speculated that manipulation of the catheter and the underlying Takayasu arteritis caused cardiac arrest. It is also considered that hypovolemia was induced by the injuries of the right common iliac artery and vein caused during the insertion of the PCPS venous cannula. In addition, the right atrium was injured by the edge of the PCPS cannula, leading to hemopericardium. In pediatric cases involving PCPS, or in cases where cannulation is difficult, regular examination of the pericardial and abdominal cavities by echocardiography would provide useful information to prevent such accidents.

From the Departments of *Legal Medicine and †Pathology, Iwate Medical University School of Medicine, Morioka, Iwate, Japan.

Manuscript received March 4, 2007; accepted September 14, 2007.

Reprints: Masataka Takamiya, MD, PhD, Department of Legal Medicine, Iwate Medical University School of Medicine, 19–1 Uchimaru, Morioka, Iwate, Japan 020–8505. E-mail: mtakamiy@iwate-med.ac.jp.

© 2010 Lippincott Williams & Wilkins, Inc.