EXTRACORPOREAL MEMBRANE-OXYGENATION AND THE TREATMENT OF CRITICAL PULMONARY-HYPERTENSION IN CONGENITAL HEART-DISEASE

Certain forms of congenital heart disease (CHD) confer a high risk for the development of severe pulmonary hypertension before and after cor rective cardiac surgery. Extracorporeal membrane oxygenation (ECMO) ha s theoretical benefits in the treatment of this complication in that i t assures oxygenation, corrects acid-base balance and provides haemody namic support at the same time as allowing lung rest from ventilation. We examined our experience of the 117 children and neonates supported with ECMO between November 1989 and July 1993. Of these, five receive d support for critical pulmonary hypertension associated with congenit al heart disease. They comprised three who had undergone surgical repa ir of CHD, one whose total anomalous pulmonary venous drainage was dia gnosed and corrected whilst on ECMO and one neonate with functional pu lmonary atresia. Pulmonary artery pressure (PAP) was estimated by Dopp ler echocardiography in all patients and confirmed invasively in two. The median systolic PAP was 46 (range 42-65) mmHg prior to ECMO. The m edian ratio of pulmonary to systemic arterial pressure (PAP/SAP) was 0 .75 (0.70-0.92). Following ECMO of 16-120 h duration, the median systo lic PAP was 34 (30-49) mmHg with PAP/SAP 0.50 (0.35-0.60). All patient s survived and there were no complications related to ECMO. Extracorpo real membrane oxygenation is an effective treatment in critical pulmon ary hypertension and should be considered in all patients in whom this is refractory to conventional measures.