| Autor: |
Mohamed Al Kanjo, Regan E. Giesinger, Brady Thomas, Amy H. Stanford, Seth Jackson, Adrianne R. Bischoff, Patrick J. McNamara |
| Jazyk: |
English<br />Italian |
| Rok vydání: |
2024 |
| Předmět: |
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| Zdroj: |
Journal of Pediatric and Neonatal Individualized Medicine, Vol 13, Iss 2, Pp e130203-e130203 (2024) |
| Druh dokumentu: |
article |
| ISSN: |
2281-0692 |
| DOI: |
10.7363/130203 |
| Popis: |
Congenital diaphragmatic hernia (CDH) represents a population of high risk of major cardiopulmonary decompensation. Maintenance of patency of the patent ductus arteriosus (PDA), using intravenous prostaglandin, is a strategy used by some clinicians to decrease the risk of right ventricular dysfunction. A term infant with CDH presented with pulmonary hypertension unresponsive to aggressive hemodynamic support. Within 12 hours of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) initiation, circuit chugging occurred that was refractory to multiple volume boluses. Targeted neonatal echocardiography (TnECHO) revealed a high-volume left-to-right shunt across the PDA, resulting in decreased blood return to the right atrium. Interventions aimed at reducing the left-to-right PDA shunt led to the resolution of circuit chugging. This report highlights the unique challenge of VA-ECMO flow in the setting of a large PDA and the consequences of interventions, increasing PDA diameter or lowering pulmonary vascular resistance, on the magnitude of systemic-pulmonary shunting and systemic blood flow. TnECHO played a vital role in monitoring hemodynamics and guiding ECMO adjustments. |
| Databáze: |
Directory of Open Access Journals |
| Externí odkaz: |
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