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Postcardiotomy LVAD support and transesophageal echocardiography in a child
S A Scheinin1, B Radovancevic, D A Ott
1Department of Cardiovascular Surgery, Texas Heart Institute, Houston 77225-0345.
Insights
A 5-year-old boy experiencing postcardiotomy cardiogenic shock after ventricular septal defect repair was successfully treated with mechanical circulatory support. A left ventricular assist device facilitated native heart recovery within 50 hours.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Congenital ventricular septal defects (VSDs) are common heart abnormalities requiring surgical repair.
- Postcardiotomy cardiogenic shock (PCCS) is a rare but serious complication following cardiac surgery.
- Mechanical circulatory support (MCS) offers a potential solution for managing severe PCCS.
Observation:
- A 5-year-old boy developed PCCS after VSD repair.
- MCS was initiated using a centrifugal left ventricular assist device (LVAD).
Findings:
- The centrifugal LVAD provided effective hemodynamic support for 50 hours.
- Native left ventricular function recovered sufficiently for LVAD weaning.
- Transesophageal echocardiography (TEE) was instrumental in monitoring left ventricular function.
Implications:
- MCS, specifically LVADs, can be a life-saving intervention for pediatric PCCS.
- TEE is a valuable tool for guiding the management and de-escalation of MCS.
- This case highlights the successful application of MCS in pediatric cardiac surgery for VSD repair.
Abstract:
A case of postcardiotomy cardiogenic shock after repair of a congenital ventricular septal defect in a 5-year-old boy is reported. Mechanical circulatory support, instituted with a centrifugal left ventricular assist device, adequately supported the patient for 50 hours until recovery of native left ventricular function occurred. Transesophageal echocardiography proved to be useful in assessment of left ventricular function, allowing for timely institution and withdrawal of mechanical circulatory support.