Related Experiment Videos
Pulmonary hypertension postventricular septal defect repair treated by extracorporeal membrane oxygenation
Insights
Severe pulmonary hypertension after congenital heart defect repair can be fatal. Extracorporeal membrane oxygenation (ECMO) successfully treated a refractory case in an infant, offering a new therapeutic option for this critical condition.
Area of Science:
- Pediatric Cardiology
- Cardiothoracic Surgery
- Critical Care Medicine
Background:
- Severe pulmonary hypertension is a rare but serious complication following congenital cardiac defect repair.
- Early postoperative mortality can occur due to refractory pulmonary hypertension.
Observation:
- A nine-month-old infant developed paroxysmal pulmonary hypertension and severe hypoxemia post-ventricular septal defect (VSD) repair.
- The condition was unresponsive to conventional medical and pharmacologic treatments.
Findings:
- Extracorporeal membrane oxygenation (ECMO) was successfully employed to manage the refractory pulmonary hypertension.
- ECMO facilitated the reduction of pulmonary artery pressure, allowing for weaning of pharmacologic support and eventual withdrawal of ECMO.
Implications:
- This case suggests ECMO is an effective therapy for acute pulmonary hypertension after congenital heart anomaly repair.
- Extending ECMO application to post-operative pulmonary hypertension broadens its established uses in neonates.
Abstract:
Severe pulmonary hypertension complicating the correction of congenital cardiac defects is an unusual cause of early postoperative mortality. We present a case of a nine-month-old infant who developed paroxysmal pulmonary hypertension associated with severe hypoxemia after the successful repair of a large perimembranous ventricular septal defect (VSD). The pulmonary hypertension was refractory to all medical and pharmacologic therapy but was successfully treated with extracorporeal membrane oxygenation (ECMO). On ECMO, pharmacologic support was removed, pulmonary artery pressure reduced, and ECMO support withdrawn. To date, ECMO has been applied to pulmonary hypertension of the newborn, neonatal respiratory insufficiency, and for primary cardiac pump failure. Our experience with this case leads us to believe it is an effective therapy for acute pulmonary hypertension occurring after the repair of congenital cardiac anomalies.