Obstruction of the SVC has been reported as a complication of ECMO, possibly secondary to obstruction by the jugular venous catheter or by a thrombus after decannulation. Communicating hydrocephalus (CH) has previously been reported in infants with SVC obstruction after a Mustard procedure for transposition of the great vessels. We are reporting the clinical course and developmental outcome of two infants with transient SVC syndrome during and after ECMO who subsequently developed CH during the first year of life.

Both infants were 35-36 weeks gestation and were treated with ECMO for severe respiratory failure with persistent pulmonary hypertension due to E. Coli sepsis/ pneumonia (Baby P) and respiratory distress syndrome (Baby S). Both infants had transient swelling of the upper body during ECMO and then developed chylothorax and recurrent pleural effusions in the post ECMO period. Neither infant had an intracranial hemorrhage on post-ECMO CT scan. During their follow-up, both infants were noted to have an abnormal increase in head circumference after 6 months of age with a diagnosis of CH on cranial CT scan. Infant P also had an associated subdural hematoma. On echocardiography and subsequent cardiac catheterization, infant P had complete obstruction of the SVC with a large collateral azygous vein and infant S had a short segment of total obstruction of the SVC. After failing a trial of urokinase, infant P was treated with a temporary subgaleal shunt and infant S underwent pericardial patching of the obstructed segment of his SVC. The hydrocephalus improved in infant P and totally resolved in infant S. Serial neurodevelop-mental follow-up evaluations showed progressive improvement in hypotonia and motor delays with normal cognitive development at 2 years of age.

These cases demonstrate that CH may occur during the first year of life in infants with early SVC syndrome after other clinical evidence of the condition has resolved. Infants with transient symptoms of SVC syndrome should be evaluated with echocardiography for possible residual thrombosis of the SVC in the post ECMO period. Infants who develop unexpected communicating hydrocephalus during post-ECMO follow-up should be evaluated to rule out previously undetected SVC obstruction.