Venovenous extracorporeal membrane oxygenation in patients with atrial septal defects

Abstract

Two patients presented in profound respiratory distress unresponsive to maximal support and were placed on venovenous ECMO. Subsequently, both were found to have a patent foramen ovale and high pulmonary artery pressures, resulting in a right to left shunt. Both patients had a better than expected response to ECMO, likely related to their shunts allowing oxygenated blood to bypass the high pulmonary artery pressures and go directly to the left heart. Both patients were successfully weaned from ECMO and discharged to home in good condition.

Using Transesophageal Echocardiography in Liver Transplantation with Veno-Venous Bypass Is a Tool with Many Applications: A Case Series from an Italian Transplant Center

“…However, VVB can also determine direct or indirect complications that compromise the hemodynamic stability and the patient’s outcome such as cardiac tamponade, pulmonary embolism (both thrombotic and gas emboli) and hemorrhage. In addition, bypass can also potentially facilitate paradoxical embolism through a PFO or atrial defect, especially in the post-graft reperfusion phase, in the case of pulmonary embolism (PE) and patients with porto-pulmonary hypertension (PoPH) [ 22 ].…”

Air in intravenous lines: a need to review old opinions

“…Most PFOs are detected early in life, but it is known to still be present in about 10% to 35% of adults (some report 25-45% found during autopsy) 17 and is considered to be an important risk factor for strokes, cerebrovascular accidents and transient ischemic attacks. 18 Some people know they have a PFO, but, unfortunately, many adults do not, 19 which increases the risk of PAE when air bubbles are allowed to enter the venous circulation through an IV line. This potential for PAE is a significant concern in pediatric patients with complicated anatomy or in the presence of a known PFO or ASD.…”