Limited Balloon Atrial Septostomy for Left Ventricular Unloading in Peripheral Extracorporeal Membrane Oxygenation

Pulmonary arterial hypertension is a pernicious disease with a diverse etiology in the pediatric population. Despite the increased availability of drug therapies, pulmonary arterial hypertension continues to cause significant morbidity and mortality. In pediatric patients with severe pulmonary arterial hypertension who have failed medical therapy, a few studies have demonstrated the role of balloon atrial septostomy as a bridge to lung transplantation or a means of improving symptomatology. However, no data exists on the utilization of balloon atrial septostomy as a palliative intervention to wean from extracorporeal membrane oxygenation (ECMO) when all other therapies are exhausted. Here we describe a case series of two pediatric patients with severe pulmonary arterial hypertension, requiring ECMO support, who were successfully weaned from ECMO following balloon atrial septostomy.

Download Full-text

Successful Management of a COVID-19 Positive Infant With Transposition of the Great Arteries

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211000687 ◽

2021 ◽

pp. 215013512110006

Author(s):

Tomasz J. Nabialek ◽

Naga K. Puppala ◽

Andrew Riordan ◽

Ram Ramaraj ◽

Phuoc Duong ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Prostaglandin E1 ◽

Arterial Switch Operation ◽

Left Ventricular ◽

Intact Ventricular Septum ◽

Successful Management ◽

Membrane Oxygenation ◽

Switch Operation ◽

Atrial Septostomy

A six-week-old infant presented in extremis and was diagnosed with dextro-transposition of the great arteries, intact ventricular septum, features of left ventricular deconditioning, and abnormal coronary arteries. Treatment with prostaglandin E1 and balloon atrial septostomy was insufficient, necessitating extracorporeal membrane oxygenation (ECMO). Severe acute respiratory syndrome coronavirus-2 was detected. The arterial switch operation was delayed by eight days because of COVID-19. Although stable on ECMO, the infant was treated with remdesivir. Extracorporeal membrane oxygenation was not required postoperatively with chest closure on day 2 and extubation on day 5.

Download Full-text

Cardiac catheterization in children on extracorporeal membrane oxygenation

Cardiology in the Young ◽

10.1017/s1047951100003267 ◽

1996 ◽

Vol 6 (1) ◽

pp. 59-61 ◽

Cited By ~ 15

Author(s):

José A. Ettedgui ◽

F. Jay Fricker ◽

Sang C. Park ◽

Donald R. Fischer ◽

Ralph D. Siewers ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Pulmonary Edema ◽

Left Atrium ◽

Cardiac Catheterization ◽

Femoral Vein ◽

Left Ventricular ◽

Severe Left Ventricular Dysfunction ◽

Membrane Oxygenation ◽

Diagnostic Cardiac Catheterization ◽

Atrial Septostomy

SummaryThere are limited reports in the literature that address the unique issues related to cardiac catheterization on extracorporeal membrane oxygenation. Since 1990, cardiac catheterization has been performed on nine patients on extracorporeal membrane oxygenation. The median age was 10 months (range four days to 18 years) and the median weight was 4 kg (range 2.3–73.8 kg). The indications for catheterization were to relieve pulmonary edema in five patients with severe left ventricular dysfunction, and in one instance each, evaluation of probable anomalous left coronary artery, tetralogy of Fallot associated with a diaphragmatic hernia, possible pulmonary venous abnormalities, and postoperative evaluation after an arterial switch. Venous access was obtained through a preexisting femoral venous line in six patients, and through a cutdown of the saphenous or femoral vein in the other three. Interventional catheterization procedures were performed in six of the nine patients in this group. These consisted of blade atrial septostomy followed by balloon septostomy or dilation of the atrial septum in four patients, balloon septostomy alone in one, and placement of a catheter from the left atrium to the circuit used for extracorporeal oxygenation in another. A transseptal puncture was performed in five of them. Adequate decompression of the left atrium with relief of pulmonary edema was achieved in five patients. Six of the nine children in this group died, although there were no complications or deaths related to the catheterization. Children in cardiopulmonary failure on extracorporeal support represent a population at high risk. Diagnostic cardiac catheterization and atrial septostomy to decompress the left heart, when indicated, can be performed safely in such patients.

Download Full-text

Blade and balloon atrial septostomy for left heart decompression in patients with severe ventricular dysfunction on extracorporeal membrane oxygenation

Catheterization and Cardiovascular Interventions ◽

10.1002/(sici)1522-726x(199902)46:2<179::aid-ccd13>3.0.co;2-w ◽

1999 ◽

Vol 46 (2) ◽

pp. 179-186 ◽

Cited By ~ 109

Author(s):

Paul M. Seib ◽

Sherry C. Faulkner ◽

Christopher C. Erickson ◽

Stephen H. Van Devanter ◽

James E. Harrell ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Ventricular Dysfunction ◽

Left Heart ◽

Balloon Atrial Septostomy ◽

Membrane Oxygenation ◽

Atrial Septostomy

Download Full-text

Atrial Septostomy for Left Ventricular Unloading During Extracorporeal Membrane Oxygenation for Cardiogenic Shock

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2021.09.011 ◽

2021 ◽

Vol 14 (24) ◽

pp. 2698-2707 ◽

Cited By ~ 1

Author(s):

Mikulas Mlcek ◽

Paolo Meani ◽

Mauro Cotza ◽

Mariusz Kowalewski ◽

Giuseppe Maria Raffa ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Membrane Oxygenation ◽

Atrial Septostomy

Download Full-text

Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock

Perfusion ◽

10.1177/02676591211033947 ◽

2021 ◽

pp. 026765912110339

Author(s):

Shek-yin Au ◽

Ka-man Fong ◽

Chun-Fung Sunny Tsang ◽

Ka-Chun Alan Chan ◽

Chi Yuen Wong ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Mechanical Circulatory Support ◽

Primary Outcome ◽

Left Ventricular ◽

Circulatory Support ◽

Queen Elizabeth Hospital ◽

Intra Aortic Balloon Pump ◽

Membrane Oxygenation ◽

Significant Difference ◽

Va Ecmo

Introduction: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. Methods: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients <18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. Results: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. Conclusions: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.

Download Full-text