SHA 78. Coarctation plus VSD one or two stage repair?

Abstract

two stage procedures to correct Fontan Pathology. Left Glenn shunt as first stage then fenestrated Fontan with common atrioventricular valve repair as a second stage. The patient had uneventual post operative recovery and discharge home. However, she was re-admitted few days after discharge with high fever and manifestation of respiratory chest infection. On investigation she was proven to be H1N1positive. The patient respiratory condition deteriorated dramatically within 48 h. She developed acute respiratory failure which required mechanical respiratory support. She also developed a sever heart failure which required significant chemical ion tropic support. Despite all the above measures, the patient condition continue to deteriorate and the Decision was taken to insert the extracorporeal membrane oxygenation (ECMO), as a bridge for respiratory failure recovery. The ECMO cannulation were Veno-Venous. femoral vein as input flow and internal jugular as output flow connected to pediatric oxygenator D905 with 3/8–3/8 circuit We started with one liter flow per minute, 100% FiO2, 5 L gas flow to maintain her core temperature on 36 C. she got hemofiltration as additional device attached to the circuit to help taking out the excessive fluid. As she was on ECMO for long time her creatinine and urea and lactic acid started to be elevated, so we applied dialysis system beside the regular hemofiltration. She was on heparin infusion to maintain the ACT (180–200 s) therefore, we faced bleeding problem from the cannula sides and even from the mouth. Results: The patients were assessed daily for the respiratory and haemodynamic recovery. Chest X-ray were performed daily to check for any parenchymal infiltarate recovery and the patient became H1N1 negative after 10 days. We were able to start weaning from the respiratory support after 23 days and to be weaned from the mechanical ventilation after one month. Patient however, required aggressive dietary and physiotherapy to help her regain her strength. Conclusion: Diligence, persistence and luck were the essence of this case. Early diagnosis and respiratory support may have helped in saving this child. Tracks: Cardiac Perfusion.