Unusual case of pericardial tamponade due to umbilical venous catheterization in a newborn with congenital chylothorax: Case report and review of the literature

Abstract

Pericardial tamponade occurs rarely as severe complication of umbilical venous catheterization. We describe a preterm infant with congenital hydrothorax and mild hydrops fetalis who required umbilical venous catheterization for inotropic support and parenteral nutrition. The correct position of the UVC was verified by echocardiography and chest x-ray. The infant developed respiratory failure because of an increasing right sided pleural effusion at day 4 resulting in a mediastinal shift to the left side. During drainage of the pleural effusion the infant suddenly presented with decreasing blood pressure and subsequent bradycardia requiring resuscitation. Immediate transthoracic echocardiography revealed a cardiac tamponade due to pericardial effusion and pericardiocentesis was successfully performed promptly. The patient's conditions stabilized and he was discharged from hospital at 6 weeks postnatal age without apparent sequelae. Cardiac tamponade may occur despite correct position of the umbilical venous catheter. In our case the mediastinal shift presumably caused the atrial perforation by the catheter.