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

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.

Transposition of the great vessels and intact ventricular septum: is there an age limit for the arterial switch? Personal experience and review of the literature

2020 ◽  
Vol 30 (7) ◽  
pp. 1012-1017
Author(s):  
Zied Daoud ◽  
Halkawt Ali Nuri ◽  
Ambra Miette ◽  
Giuseppe Pomè
Keyword(s):  
Myocardial Dysfunction ◽  
Arterial Switch Operation ◽  
Left Ventricular ◽  
Ventricular Septum ◽  
Circulatory Support ◽  
Intact Ventricular Septum ◽  
Arterial Switch ◽  
Switch Time ◽  
Switch Operation ◽  
Great Vessels

AbstractObjective:Prognosis of the transposition of the great arteries has completely changed since the introduction of the arterial switch. Time limit to perform this intervention is still controversial. The aim of this study is to demonstrate the early and late outcome of primary arterial switch operation beyond the age of months.Methods:We included all patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond the age of 8 weeks who underwent primary arterial switch operation. The procedures were performed by the same surgeon, in two different institutes. Patients who had transposition of the great arteries and associated anomalies (except atrial septal defect and persistent arterial duct) were excluded. Ventricular shape, geometry, and mass were not considered during the decision on procedure type.Results:In the study, 11 patients with the diagnosis of simple d-transposition of the great arteries beyond 8 weeks were undergone primary arterial switch operation with a mean age of 90.63 days (60–137 days), and 7 patients had a Rashkind procedure. All patients had squashed left ventricle shape with preserved function. The sternum was left open in 10 patients. Extracorporeal membrane oxygenation support was necessary in 45.45% of cases. The mean mechanical ventilation time was 7.27 days (1–16 days). No mortality was recorded until now. Post-operatory left ventricular function was preserved in 90.9% of the patients. Only one patient had mild myocardial dysfunction at the time of discharge.Conclusions:Primary arterial switch procedure can still be the best surgical option in patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond 8 weeks of age, providing that mechanical circulatory support and an expert cardiac intensive care unit service are available.

scholarly journals Central Extracorporeal Membrane Oxygenation to Lung Transplantation after Remote Arterial Switch Operation

2021 ◽  
Author(s):  
Adam Stephens ◽  
Dean McKenzie ◽  
Jeffrey Heinle ◽  
Ernestina Melicoff,-Portillo ◽  
Carolina Gazzaneo ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Arterial Switch Operation ◽  
Arterial Switch ◽  
Membrane Oxygenation ◽  
Switch Operation

Cardiac catheterization in children on extracorporeal membrane oxygenation

1996 ◽  
Vol 6 (1) ◽  
pp. 59-61 ◽  
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.

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