Left artrial decompression by left parasternal incision for pediatric venoarterial extracorporeal mem‐brane oxygenation:a report of 4 cases / 中国小儿急救医学

ABSTRACT

Objective To introduce the clinical experience of 4 cases of left atrial decompression via minithoracotomy technique in pediatric application under venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in pediatric fulminant myocarditis treatment. Methods The clinical data of 4 patients with VA‐ECMO support for fulminant myocarditis admitted in Zhengzhou Children′s Hospital and Bayi Children′s Hospital Affiliated to the Seventh Medical Center of PLA General Hospital from July 2017 to October 2018 were reviewed. Results A total of 4 patients with fulminant myocarditis supported by VA‐ECMO received left ventricular decompression,and left atrial decompression was performed by left atrial intubation with a small incision near the left sternum. Left heart ultrasound showed that left heart function improved after de‐compression. One case with ventilator was still Ⅲ degree atrioventricular block after weaning,and installed permanent pacemaker postoperative 1 month. One case had more pleural drainage and improved after adjus‐ting anticoagulation. One case died due to the termination of treatment by the guardian. A total of 3 cases sur‐vived,and the recent follow‐up results were satisfactory. Conclusion Left artrial decompression of this mini‐mally invasive technique can improve left ventricular function in children with fulminant myocarditis suppor‐ted by VA‐ECMO. It is safe, feasible with small trauma and bleeding controlled.