ECMO in ARDS: a long-term follow-up study regarding pulmonary morphology and function and health-related quality of life.

BACKGROUND: A high survival rate can be achieved in patients with severe acute respiratory distress syndrome (ARDS) using extracorporeal membrane oxygenation (ECMO). The technique and the costs are, however, debated and follow-up studies in survivors are few. The aim of this study was to evaluate long-term pulmonary health after ECMO and severe ARDS. METHODS: Twenty-one long-term survivors of severe ARDS and ECMO were studied in a follow-up program including high-resolution computed tomography (HRCT) of the lungs, extensive pulmonary function tests, pulmonary scintigraphy and the pulmonary disease-specific St George's Respiratory Questionnaire (SGRQ). RESULTS: The majority of patients had residual lung parenchymal changes on HRCT suggestive of fibrosis, but the extension of morphologic abnormalities was limited and without the typical anterior localization presumed to indicate ventilator-associated lung injury. Pulmonary function tests revealed good restitution with mean values in the lower normal range, while T(1/2) for outwash of inhaled isotope was abnormal in all patients consistent with subclinical obstructivity. Most patients had reduced health-related quality of life (HRQoL), according to the SGRQ, but were stating less respiratory symptoms than conventionally treated ARDS patients in previous studies. The majority were integrated in normal work. CONCLUSION: The majority of ECMO-treated ARDS patients have good physical and social functioning. However, lung parenchymal changes on HRCT suggestive of fibrosis and minor pulmonary function abnormalities remain common and can be detected more than 1 year after ECMO. Furthermore, most patients experience a reduction in HRQoL due to the pulmonary sequelae.

Detachment of the septal tricuspid leaflet during transatrial closure of isolated ventricular septal defect.

In 27 (18%) of the 151 patients who underwent transatrial closure of isolated ventricular septal defect (VSD) between 1966 and 1979, the tricuspid valve was partially detached in order to achieve better exposure. All 27 patients had defects of the membranous or paramembranous type situated behind the tricuspid septal cases, tight chordae tendineae crossed over the defect and inserted in the edge of the VSD. A 15 to 20 mm incision in the septal leaflet was usually needed to expose the defect sufficiently. There were two operative deaths among the 27 patients, both unrelated to the tricuspid incision. The remaining patients had uncomplicated postoperative courses. There were no long-term complications or instances of significant tricuspid valve incompetence, major residual shunt, or heart block at follow-up. Three patients, operated upon at the ages of 3, 3, and 6 years, respectively, had residual pulmonary hypertension. In one patient, who died 4 years postoperatively in a traffic accident, the tricuspid valve was intact and the previous incision could hardly be seen. It is concluded that detachment of the septal tricuspid leaflet is a safe procedure during transatrial closure of a VSD.