Extracorporeal membrane oxygenation for circulatory support after repair of congenital heart defects.

Extracorporeal membrane oxygenation was used for cardiovascular support in 13 infants and children with complex congenital heart disease and 1 premature neonate treated in preparation for pericardial patch tracheoplasty for long-segment tracheal stenosis. Nine patients were weaned from extracorporeal membrane oxygenation. There were five (36%) early deaths and four (29%) late deaths. Cannulation sites included right carotid/jugular vessels, femoral artery and vein, and right atrium and aorta. In 4 patients, the neck vessels were repaired at decannulation. Five survivors had normal growth and neurodevelopmental evaluations at follow-up. Extracorporeal membrane oxygenation can be successfully used as biventricular support in patients with intractable low cardiac output syndrome after repair of congenital heart disease. Best results are obtained in patients who have several hours of stability after operation before initiation of support. Hemorrhagic complications are reduced and long-term neurodevelopmental outcomes appear promising with right neck vessel cannulation and repair. No bleeding complications were observed in patients cannulated through the neck vessels.

Transluminal balloon dilatation for discrete subaortic stenosis.

Ten children, 10 weeks to 18 years old, with discrete subaortic stenosis (DSS) underwent transluminal balloon dilatation of the subaortic obstruction. The DSS was visualized by 2-dimensional echocardiography and cineangiography. Six patients had a thin discrete "membrane" immediately below the aortic valve (group I) and 4 patients had a thicker fibromuscular ring about 1 cm below the aortic valve (group II). In group I, the mean gradient decreased from 82 +/- 49 mm Hg (range 35 to 164) to 22 +/- 15 mm Hg (range 5 to 40); in group II, it decreased from 155 +/- 18 mm Hg (range 132 to 177) to 85 +/- 44 mm Hg (range 60 to 150). Three patients had follow-up cardiac catheterization 1 year later. Their mean gradient soon after the procedure was 37 +/- 23 mm Hg. On follow-up, it was still 37 +/- 19 mm Hg, indicating persistence of relief of the obstruction. Because of the high residual gradient in group II, 3 patients had surgical relief of the obstruction. The degree of aortic regurgitation present before the dilatation in all 10 patients did not change after the procedure. The mechanism of relief of the obstruction was by tearing of the subaortic membrane. Our data suggest that relief of subaortic obstruction is more favorable in the thin, membranous DSS.

Successful balloon valvuloplasty for neonatal critical aortic stenosis.

Transluminal balloon aortic valvuloplasty was performed in two term neonates, ages 6 and 7 days, with critical aortic stenosis. Transluminal balloon coarctation angioplasty was also performed in the second neonate. The neonates presented in congestive heart failure and underwent unsuccessful treatment with digoxin, furosemide, and careful fluid management before balloon dilatation. In the first patient, the gradient across the aortic valve was reduced from 75 mm Hg before balloon aortic valvuloplasty to 34 mm Hg after the procedure. The second neonate showed clinical improvement after both dilatation procedures. In both patients, follow-up clinical and Doppler echocardiography findings suggest persistent improvement 5 months after the procedure.