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PEDIATRIC ANESTHESIA

Infantile Major Airway Stenosis and Acute Respiratory Distress Associated with Cardiac Tamponade

Spyros D. Mentzelopoulos, MD, PhD, DEAA^*, Maria Tzoufi, MD, DEAA, and Georgia Kostopanagiotou, MD, PhD

*Department of Pediatric Cardiac Anesthesiology, Agia Sofia Children’s Hospital; and Department of Intensive Care Medicine and Second Department of Anesthesiology, University of Athens Medical School, Attikon University Hospital, Athens, Greece

Address correspondence and reprint requests to Spyros D. Mentzelopoulos, MD, PhD, DEAA, Department of Intensive Care Medicine, Attikon University Hospital and Department of Pediatric Cardiac Anesthesiology, Agia Sofia Children’s Hospital, 12 Ioustinianou St., GR-11473, Athens, Greece. Address e-mail to sdm{at}hol.gr.

Coxsackie virus pericarditis caused cardiac tamponade in a 45-day-old infant with corrected total anomalous pulmonary venous drainage and a hypodynamic left heart. The pathophysiology comprised reduced heart compliance, venous return impairment, acute pulmonary hypertension, and increased airway microvascular permeability. Tracheal edema and external compression caused tracheal lumen narrowing and respiratory failure. Laryngoscopy was difficult because of laryngeal inlet swelling. Endotracheal intubation was accomplished with a 3.0-mm tube. Pericardial cavity evacuation resulted in rapid recovery. A postprocedural chest radiograph revealed tracheal lumen enlargement. Repeated laryngoscopy revealed resolution of upper-airway edema. In infants, large pericardial effusions developing after corrective/palliative heart surgery may cause major airway compromise.