Extracorporeal membrane oxygenation and the treatment of critical pulmonary hypertension in congenital heart disease

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Abstract
Certain forms of congenital heart disease (CHD) confer a high risk forthe development of severe pulmonary hypertension before and aftercorrective cardiac surgery. Extracorporeal membrane oxygenation (ECMO) hastheoretical benefits in the treatment of this complication in that itassures oxygenation, corrects acid-base balance and provides haemodynamicsupport at the same time as allowing lung rest from ventilation. Weexamined our experience of the 117 children and neonates supported withECMO between November 1989 and July 1993. Of these, five received supportfor critical pulmonary hypertension associated with congenital heartdisease. They comprised three who had undergone surgical repair of CHD, onewhose total anomalous pulmonary venous drainage was diagnosed and correctedwhilst on ECMO and one neonate with functional pulmonary atresia. Pulmonaryartery pressure (PAP) was estimated by Doppler echocardiography in allpatients and confirmed invasively in two. The median systolic PAP was 46(range 42- 65) mmHg prior to ECMO. The median ratio of pulmonary tosystemic arterial pressure (PAP/SAP) was 0.75 (0.70-0.92). Following ECMOof 16- 120 h duration, the median systolic PAP was 34 (30-49) mmHg withPAP/SAP 0.50 (0.35-0.60). All patients survived and there were nocomplications related to ECMO. Extracorporeal membrane oxygenation is aneffective treatment in critical pulmonary hypertension and should beconsidered in all patients in whom this is refractory to conventionalmeasures.

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