Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants.

Although the poly-methylpentene (PMP) oxygenators have significant advantages in ECMO implementation, their usage may be limited in some situations, which may be related to economic constraints. In this report, we aimed to emphasize our cost-effective usage of a membrane oxygenator at the ECMO setup. We implemented ECMO with eight Capiox® FX05 or Baby RX05 hollow-fiber membrane oxygenators in five neonatal patients. The average ECMO duration was 121 hours (ranging from 41 to 272 hours). Following the termination of the ECMO, the system was broken down into its components for macroscopic analysis. Neither gross blood clots nor plasma leakage were observed in any of the components. The integration of a centrifugal pump and a separate hollow-fiber oxygenator may provide a cost-effective ECMO implementation setup with no adverse effects which may be an encouraging alternative for the low cost usage of ECMO in neonates.

Atrial natriuretic peptide: could it be a marker for postoperative recurrent effusions after Fontan circulation in complex congenital heart defects?

Fontan operation and its modifications are used for the physiological correction of complex congenital heart malformations with functionally single ventricle. Atrial natriuretic peptide (ANP), a physiological diuretic and vasodilator that--together with the effects of cardiopulmonary bypass--plays an important role in the augmentation of capillary permeability in Fontan patients. The rise in right atrial pressure and wall stress is an important stimulus for the release of ANP. ANP levels were measured before and early after surgery in Fontan group (n = 20) and control group (n = 20, patients with simple cardiac defects) to study its influence on and association with mean right atrial pressure, pulmonary vascular resistance (PVR), systemic vascular resistance, amount of drainage during early and late postoperative period, duration of intensive care unit and hospital stay, and need for colloid supplement. Early postoperative ANP values showed a negative correlation with PVR (r = -0.55) and total drainage (r = -0.88). There was no significant change in ANP during surgery or in the postoperative period in control patients. Reduction of PVR and maintenance of efficient urine output are important in the management of Fontan circulation. We conclude that high levels of ANP measured early after Fontan operation can be used as a marker for the successful establishment of Fontan circulation in patients with complex congenital heart defects.

Early results of valved bovine jugular vein conduit for right ventricular outflow tract reconstruction.

OBJECTIVE: Many congenital cardiac anomalies present with accompanying severe right ventricular outflow tract (RVOT) obstruction or interruption requiring surgical correction. RVOT reconstruction by means of a conduit is often necessary in the majority of these patients in the early years of life and there are several proposed conduits for this purpose. METHODS: Fourteen patients with different congenital cardiac pathologies underwent RVOT reconstruction with the newly developed bovine valved jugular vein conduit (The Contegra conduit). The function of the conduit is observed by echocardiographic examinations at the hospital discharge and at follow-up visits with special attention to the function of the venous valve and to any gradient on the RVOT. RESULTS: There were two perioperative mortalities. All the surviving patients are followed for a mean period of 8.07 months (range 2 to 33 months). The function of the venous valve was determined, in 4 patients (33.33%) as without regurgitation, in 7 patients (58.3%) as mild regurgitation and in 1 patient (8.33%) as mild-to-moderate regurgitation. The reconstructed RVOT was free of any significant gradient at the hospital discharge (mean 10.83 +/-10.18 mmHg) and at the follow-ups (mean 12.916 +/-12.33 mmHg). There was not a trend towards an increase in the gradients following discharge. CONCLUSION: The early results of the Contegra valved conduit are very satisfactory. This graft can be a good alternative for RVOT reconstruction, particularly in the neonatal and infant patient group. These patients can be managed by homograft replacement of their conduit in later years.

Prenatal echocardiographic diagnosis of situs inversus totalis and transposition of the great arteries: a case report.

A case of situs inversus totalis and transposition of the great arteries (TGA) was diagnosed prenatally at 25 weeks' gestation. Postnatal echocardiographic examination confirmed the antenatal findings. This case underscores the importance of recognizing situs abnormalities during obstetric and fetal echocardiographic examination, as they are often associated with cardiac anomalies. Accurate prenatal diagnosis of structural heart defects is extremely important in family counselling and in planning obstetric and postnatal treatment.

Combined internal mammary artery graft for coronary artery revascularization.

Five patients with multiple-vessel coronary artery disease underwent isolated coronary artery bypass grafting with a technique involving both internal mammary arteries and a small piece of interposed saphenous vein. The combined internal mammary artery grafts were used for sequential grafting. A total of 20 anastomoses were performed (average number, 4 anastomoses per patient). There were no operative deaths. Postoperative complications included reoperation for bleeding in 1 patient and diaphragmatic dysfunction in another. Postoperative coronary angiography 2 days before discharge (mean time, 10 days postoperatively) revealed that all the sequential anastomoses with the combined IMA graft were patent. Exercise tolerance tests performed 3 and 11 months postoperatively indicated excellent results and no ischemia. Based on this experience, we conclude that this method appears promising for multivessel coronary artery bypass grafting.