This report describes the case of a neonate with d-transposition of the great arteries and severe pulmonary arterial hypertension stabilised in the post-operative period with continuous iloprost nebulisation. To our knowledge, this is the first documented method of treating post-operative severe pulmonary arterial hypertension with continuous inhaled iloprost in a patient with complex CHD. We found this method of delivering the drug very effective in stabilising haemodynamic swings in the setting of severe pulmonary arterial hypertension.
The purposes of this study were to quantify the insensible water loss that occurs across the Medtronic Minimax oxygenator and to estimate the resultant rise in fluid sodium concentration.A Carmeda-coated extracorporeal membrane oxygenation circuit connected to a Medtronic Minimax Plus oxygenator was primed with normal saline and attached to a closed reservoir. The gas sweep was randomly assigned to one of three rates: 2, 5, or 10 LPM (liters per minute). Each sweep rate was run in triplicate. The sodium concentration of the circuit was assessed after 12 and 24 hours of each trial. At the end of each 24-hour run, the evaporative loss was calculated. The average insensible water losses were 6.9+/-0.4 ml/h, 16.6+/-1.5 ml/h, and 34.4+/-0.3 ml/h at gas sweep rates of 2, 5, and 10 LPM, respectively (p<0.0001). Daily evaporative water losses for the membrane can be estimated to be 82.7+/-2.2 ml for each 1 LPM of sweep gas flow for a normal saline pump flow of 300 ml/min. In a closed circuit, a faster sweep gas rate is associated with a more rapid rise in sodium concentration (p<0.0001).
Excellent results are expected for children undergoing HTx with comparable results among diagnostic groups. Pretransplant mechanical circulatory support and posttransplant mechanical circulatory support are risk factors for decreased survival. Survival after transplantation for HLHS or HLHS-related malformation is better with primary HTx in comparison to HTx after prior cardiac surgery.
This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan-Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.
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