TOTAL ANOMALOUS PULMONARY VENOUS CONNECTI ON - STABILIZATION ON VENOVENOUS EXTRACORPOREAL LUNG SUPPORT BEFORE SURGERY

Background. Total anomalous pulmonary venous return (TAPVR) is a rare congenital cardiac disease. When this includes pulmonary artery hypert ension, the infant is severely ill. Survival beyond infancy is rare wi thout surgical correction. Case report : A girl in whom hydramnios and a short femur were discovered by ultrasonography at the 25th week of gestation was admitted to the intensive care unit a few hours after bi rth because of respiratory distress. Blood PaO2 was 37 mmHg, PaCO2, 36 mmHg, and pH 7.25. She had tachycardia (190/min) and circulatory insu fficiency. Echocardiography showed right ventricular overload, a right -to-left shunt through a patent ductus arteriosus and foramen ovale an d tricuspid insufficiency. This refractory hypoxemia was not corrected by conventional respiratory support, high-frequency oscillation plus dobutamine and dopamine followed by noradrenaline infusion. Because of further deterioration, the baby was given extracorporeal lung support ; this rapidly improved the respiratory and hemodynamic conditions. Pe rsistent pulmonary artery hypertension led to a second investigation t hat showed TAPVR She underwent emergency surgery. Conclusion. Extracor poreal lung support can stabilize a precarious state in a case of seve re congenital cardiac disease, so allowing surgical treatment under sa tisfactory conditions.