| 摘要 |
A 3-month-old male infant with complex congenital heart defect underwent total surgical correction. Aortic clamp time was 146 minutes. The patient could not be weaned off from cardiopulmonary bypass, and needed veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support. However, blood persistenly gushed out of the endotracheal tube after the ECMO use. Reexploration on the first postoperative day found bilateral lung congestion and hemorrage, distended left heart with high pressure. Left atrial vent, was set up to decrease its high pressure, which drained blood to venous route of the ECMO. Pulmonary hemorrhage dramatically decreased thereafter. However, the patient could not be weaned from the ECMO support due to severe bilateral lung damage. Multiple organ failure deveolped 7 days later, and we turned off the ECMO support because of his grim prognosis.
ECMO returned oxygenated blood to the ascending aorita and therefore increased left ventricular afterload in this patient. This further compromised the poor cardiac function, and ensued a vicious cycle. The final result was distended left heart with high pressure in it. The high pressure transmitted back to pulmonary vessels and caused the pulmonary hemorrhage. Therefore, when ECMO support was used for heart failure, be careful of the complcations subsequent to left heart distension and its high pressure and intervention is indicated when occurs. |
