Ventricular Assist Device Application With the Intermediate Use of a Membrane Oxygenator as a Bridge to Pediatric Heart Transplantation (original) (raw)
Related papers
Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery
European Journal of Cardio-Thoracic Surgery, 2004
Objective: Fulminant myocarditis (FM) is uncommon and may be followed by a rapidly intractable cardiogenic shock. We report five consecutive patients with FM successfully bridged to recovery with a mechanical paracorporel biventricular assist device (BiVAD). Methods: Five patients, four adults and one child (mean age 27C/K6 years, range, 5-36 years) underwent implantation from November 1999 to May 2003, for FM. Prior to implantation, all patients required maximal inotropic support, three of them had an intra-aortic balloon pump, the child had an extra-corporel membrane oxygenation (ECMO) support previously inserted in another institution. Cardiac catheterisation showed a mean CPW of 37C/K1 mmHg, mean CVP 18C/K2 mmHg, and mean CI 1.7C/K0.1 l/min. Echocardiogram showed a severe biventricular hypokinesia, without any ventricular dilatation and a mean LVEF at 12.5%. Two patients were implanted in cardiac arrest under external cardiac resuscitation. All patients underwent BiVAD implantation (MEDOS HIA-VAD). A 72 ml right paracorporel ventricle (a 23 ml in the child) was instituted between the double stage venous canula used during CPB and a pulmonary artery outflow canula. A 80 ml left paracorporel ventricle (a 25 ml in the child) was instituted between a left ventricle apical canula and an aorta outflow canula. Results: There was no death. The mean duration support time was 11C/K6 days (from 7 to 21 days). Two patients experienced transitory deficiency due to a stroke. Four patients showed signs of FM on histological findings. Despite serologic examination and viral genome research on myocardial biopsies, pathogenic agents were not identified. At mean follow-up of 31C/K15 months, all the patients fully recovered with a mean LVEFZ60% and no left ventricular dilatation. Conclusions: In FM with intractable cardiogenic shock, the use of a BiVAD as a bridge to recovery is a life saving approach and should be considered before multi-end organ failure.
Extracorporeal membrane oxygenation in the management of cardiac failure secondary to myocarditis
Journal of Pediatric Surgery, 1993
While most patients with viral myocarditis have a relatively uncomplicated clinical course, a small number of patients will present with cardiogenic shock unresponsive to standard medical therapy. We describe the clinical course of three patients who developed profound cardiac failure secondary to a documented viral myocarditis. Each patient was managed using venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support using the right common carotid artery/internal jugular vein for cannulation. While undergoing ECMO support, each patient developed elevated leftsided cardiac chamber pressures with resultant pulmonary edema. This was managed by balloon atrial septostomy in two cases and combined blade/ balloon atrial septostomy in one case. Excellent decompression of the left heart was achieved in each patient. Two patients were successfully weaned from ECMO and are currently alive, with one demonstrating residual cardiac dysfunction. One patient developed global myocardial necrosis and ultimately died. This small series demonstrates a role for ECMO in the management of cardiac failure due to acute viral myocarditis unresponsive to medical therapy. Our experience also suggests that balloon atrial septostomy may be useful to decompress the left atrium and ventricle of patients with acute myocarditis while on ECMO.
Transplantation proceedings, 2003
T HE PROGNOSIS of patients with end-stage cardiomyopathy is poor, and heart allograft transplantation remains the standard treatment modality with well documented long-term results. 1 Primary graft failure with subsequent nonweaning from cardiopulmonary bypass (CPB) is a life-threatening condition with poor outcome. It demands swift and resolute intervention. Due to threshold levels of inotropic drug support the success of pharmaceutical treatment is, however, limited. If weaning from the cardiopulmonary bypass in our patients cannot be achieved by conservative therapeutic means, we formerly opted for insertion of a right ventricular assist device (RVAD). Since extracorporeal membrane oxygenation (ECMO) has been successfully used in our institution for patients with pulmonary hypertension undergoing bilateral lung transplantation thereby limiting reperfusion edema after lung transplantation, 2,3 we recently embarked on inserting ECMO via venoarterial access in cardiac allograft recipients with primary graft failure. The intention of this clinical trial was to retrospectively compare the impact of RVAD versus ECMO on successful weaning and patient survival after early cardiac allograft malfunction.
Successful treatment of fulminant myocarditis in a 7 year old with a left ventricular assist device
Mechanical Circulatory Support, 2011
We present a case of a 7-year-old, 20-kg male child, admitted in our Center with a diagnosis of fulminant myocarditis with a large pericardial effusion and severe hemodynamic instability. Due to failure of medical therapy, a left ventricular assistant device (LVAD) was implanted. After 4 days, the patient was successfully weaned from mechanical support. Myocardial biopsy showed evidence of acute viral myocarditis. Our experience suggests that the left ventricular assist device therapy might offer circulatory support in pediatric cases of fulminant myocarditis.