ECMO support for late presenting arterial switch operation; case report and review of literature

IF 0.3 Q4 CRITICAL CARE MEDICINE Egyptian Journal of Critical Care Medicine Pub Date : 2018-12-01 DOI:10.1016/j.ejccm.2018.12.005
Mohamed Salim Kabbani , Hussam K. Hamadah
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引用次数: 1

Abstract

Infants presenting for late arterial switch operation are at risk of myocardial depression and cardiac arrest due left ventricle deconditioning. In this report we present a female infant diagnosed to have transposition of great arteries (TGA) with intact septum who presented at 3 months of age for late arterial switch operation. Prior to surgery, the left ventricle size and mass index appeared to be satisfactory in term of muscular size and function. She underwent late arterial switch operation (ASO). Soon after surgery, the infant developed myocardial depression with hemodynamic instability and high left atrial pressure associated with left atrial dilatation. ECMO was deployed and patient stayed 10 days on ECMO until left cardiac function recovered. The infant was decannulated successfully and was subsequently discharged home with acceptable cardiac function.

In conclusion, patients presenting for late arterial switch operation are at risk for left ventricular deconditioning and pulmonary hypertension. Deconditioned left ventricle may fail post repair with inability to handle systemic circulation. Among limited options for these challenging cases primary ASO with integrated ECMO support can be used to allow deconditioned left ventricle to recover its function and ability to handle systemic circulation.

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晚期动脉切换手术的ECMO支持病例报告及文献复习
晚期动脉转换手术的婴儿有心肌抑制和心脏骤停的风险。在这个报告中,我们提出了一个女婴诊断为大动脉转位(TGA)与完整的隔膜谁提出了3 月龄晚期动脉开关手术。手术前,左心室大小和质量指数在肌肉大小和功能方面似乎令人满意。她接受了晚期动脉开关手术(ASO)。手术后不久,婴儿出现心肌抑制,血流动力学不稳定,左房压高,伴有左房扩张。采用ECMO,患者在ECMO上停留10 天,直到左心功能恢复。婴儿成功脱管,随后出院,心脏功能可接受。结论:晚期动脉转换手术患者有左心室功能障碍和肺动脉高压的风险。去条件化的左心室可能在修复后因无法处理体循环而失效。对于这些具有挑战性的病例,在有限的选择中,可以使用综合ECMO支持的原发性ASO,使条件不佳的左心室恢复其功能和处理体循环的能力。
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来源期刊
自引率
0.00%
发文量
5
审稿时长
42 weeks
期刊介绍: The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.
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