Venopulmonary ECMO Improved Hypoxemia and Supported the Right Ventricle in a Patient with Decompensated Eisenmenger Syndrome

Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.

Monitored anesthesia care for craniotomy in a patient with Eisenmenger syndrome:A case report

BACKGROUND Eisenmenger syndrome(ES)is an uncorrected congenital cardiac defect with a left-to-right shunt,leading to pulmonary arterial hypertension.Patients with ES are susceptible to hemodynamic alterations during noncardiac surgery with general anesthesia,which increases perioperative morbidity and mortality.Monitored anesthesia care(MAC)is often used during minor procedures in patients with cardiac disease.However,few reports on MAC in patients with ES exist.CASE SUMMARY A 49-year-old man was admitted for a severe headache lasting 30 d.He had been diagnosed with a large perimembranous ventricular septal defect(VSD)with bidirectional shunt flow and pulmonary arterial hypertension 10 years ago.A round mass in the right frontal lobe was revealed by Magnetic resonance imaging.Stereotactic aspiration using a neuronavigation system was performed under MAC.The patient was stayed in the hospital for 5 d,and discharged without complications.CONCLUSION MAC may be effective for craniotomy in patients with ES.

Carvedilol therapy for patients with Eisenmenger syndrome

Background： Eisenmenger syndrome is characterized by the development of pulmonary arterial hypertension with resultant intracardiac right-to-left shunt and hypoxemia in patients with congenital heart defects. In clinical practice, we found that these patients might benefit from carvedilol therapy. Thus, we designed this prospective, open label, observational study to evaluate the efficacy of carvedilol for patients with Eisenmenger syndrome. Methods Twenty patients（17.5 ± 4.8 years） with Eisenmenger syndrome were treated with carvedilol for 6 weeks. The efficacy of carvedilol on 6-minute walking distance, World Health Organization（WHO） functional class, arterial oxygen saturation and right ventricle systolic pressure were assessed.Results At the end of observation, change from baseline in 6-minute walking distance increased 36.35 meters（95% confidence intervals [CI] 25.43 to 47.27 m, P 〈 0.01）. WHO functional class was also significantly improved（P 〈 0.05）. Change from baseline in right ventricular systolic pressure assessed by echo was reduced by 8.11 mm Hg（95% confidence intervals [CI],-10.78 to-5.44 mm Hg, P 〈 0.05）. However, arterial oxygen saturation remained unchanged（87.5 ± 3.02 % at baseline versus 87.80 ± 7.29 % at the end of observation）. Conclusions Carvedilol can improve clinical function, symptoms as well as exercise capacity in patients with Eisenmenger syndrome. These findings need to be confirmed in further randomized clinical trials.

Anesthetic management of a pregnant patient with Eisenmenger’s syndrome:A case report

BACKGROUND Eisenmenger’s syndrome(ES)is a rare complication of congenital heart disease that includes pulmonary artery hypertension and reversed or bidirectional shunts.The mortality rate of pregnant women with ES is 30%-70%due to pathophysiological deterioration.Successful perioperative management of a pregnant patient with ES is a challenge for anesthesiologists.CASE SUMMARY A 38-year-old pregnant woman was admitted to the cardiology department of our hospital at 22 wk of gestation with complaints of chest tightness and shortness of breath for 3 wk.Transthoracic echocardiography revealed a bidirectional shunt between the descending aorta and pulmonary artery after interventional closure of the patent ductus arteriosus and severe pulmonary hypertension.ES in pregnancy was our primary suspicion.The patient elected to terminate the pregnancy under adequate preoperative preparation,rigorous intraoperative monitoring,and perfect epidural anesthesia.She was discharged successfully on postoperative day 16.CONCLUSION Our experience in this case suggests that successful outcomes are possible in pregnant patients with ES for termination of pregnancy under epidural anesthesia and intensive monitoring.