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Right arrow Extracorporeal circulation

Ann Thorac Surg 2005;79:2155-2158
© 2005 The Society of Thoracic Surgeons

Case report

Preoperative ECMO in Transposition of the Great Arteries With Persistent Pulmonary Hypertension

Sophie Jaillard, MDa,*, Emre Belli, MDe, Thameur Rakza, MDb, Benoit Larrue, MDc, Eric Magnenant, MDb, Christian Rey, MDd, Laurent Storme, MDb

a Services de Chirurgie Thoracique, CHRU de Lille, Lille, France
b Service de Medecine Neonatale, CHRU de Lille, Lille, France
c Service de Chirurgie Cardiaque, CHRU de Lille, Lille, France
d Service de Cardiologie Pediatrique, CHRU de Lille, Lille, France
e Service de Chirurgie Cardiaque, Hôpital Marie-Lannelongue, Le Plessis Robinson, France

Accepted for publication December 2, 2003.

* Address reprint requests to Dr Jaillard, Clinique de Chirurgie Thoracique, Hôpital Albert Calmette, Centre Hospitalier Régional Universitaire CHRU, 59037 Lille Cedex, France (E-mail: sjaillard{at}chru-lille.fr).

Persistent fetal circulation in transposition of the great arteries results in severe persistent pulmonary hypertension, which increases the risk of early mortality. We report the case of a newborn with transposition of the great arteries and intact ventricular septum associated with pulmonary hypertension. After the failure of immediate balloon atrial septostomy and supportive therapy including inhaled nitric oxide, preoperative extracorporeal membrane oxygenation reversed pulmonary hypertension and ventricular insufficiency and preceded a safe, delayed, cardiac surgical procedure. Unlike the authors of the other few case reports on this subject, we recommend a preoperative stabilization period after discontinuation of extracorporeal membrane oxygenation to avoid left ventricular "deconditioning" and postoperative deterioration related to recurrent persistent pulmonary hypertension.




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