Waardenburg Syndrome and Left Persistent Superior Vena Cava

Bilateral cochlear implantation in a child with Waardenburg syndrome: A case report

BACKGROUND

Waardenburg syndrome (WS) is a rare genetic disorder that presents with clinical characteristics such as white forelock, congenital deafness, dystopia canthorum, and heterochromia iridis. It is mostly transmitted through an autosomal dominant mode, with a few genetic mutations. Children with WS often require surgical intervention at an early age and may have a difficult airway, which can be challenging for anesthesiologists.

CASE PRESENTATION

We report the anesthetic management during cochlear implantation in a 14-month-old girl with WS who weighed 9 kg. In addition to hearing loss and delayed speech, she presented with motor developmental delay, chewing and swallowing impairments, and dietary bucking. Resistance was encountered during tracheal intubation after anesthesia induction, and the tracheal tube was successfully intubated after rotation.

CONCLUSIONS

We report the anesthetic management during cochlear implantation in a child with WS, briefly describe the research advances related to WS, and discuss the optimization of the perioperative management of these children, including airway management, anesthesia-related complications, and the use of anesthetics.

Perioperative Care of a Patient With Waardenburg Syndrome

Waardenburg syndrome is a genetic disorder, resulting in defective control of the division and migration of neural crest cells including the melanocyte lineage during embryonic development. Primary involvement of melanocytes results in the characteristic phenotypic involvement including a white forelock, vitiligo, and heterochromia. Involvement of the organ of Corti leads to sensorineural hearing loss. Involvement of the craniofacial mesenchyme results in abnormal facial features, airway abnormality, and upper limb involvement malformations. Given the potential for end-organ involvement, surgical intervention may be required. Specific concerns during anesthetic care include the potential for difficulties with endotracheal intubation, tracheal involvement, impairment of communication related to deafness, and associated congenital heart disease.

Superior Vena Cava Duplication: The Red Herring of Central Line Placement

5 million central venous access lines are placed every year in the United States, and it is a common surgical bedside procedure. We present a case of a central venous catheter placement with port for chemotherapy use, during which a duplication of a superior vena cava was discovered on CTA chest after fluoroscopy could not confirm placement of the guidewire. Due to its potential clinical implications, superior vena cava duplication must be recognized when it occurs.