Reverse aortic arch flow secondary to severe pulmonary hypertension in theneonate

The purpose of this study is to determine the incidence of reverse aortic a rch flow in newborn infants with pulmonary hypertension, and no other ident ifiable cause for flow reversal, being considered for extracorporeal membra ne oxygenation (ECMO) 2) compare the left ventricular output, and 3) outcom es, of these infants, with those in the group of patients with normal arch flow. We reviewed the medical records and echocardiograms of all infants re ferred to our institution for extracorporeal membrane oxygenation support f or pulmonary hypertension, between August 1994 and April 1996. Neonates wit h pulmonary hypertension and reverse aortic arch flow had significantly low er left ventricular output (p = 0.005), and had significantly higher mortal ity (p = 0.04), than those with normal aortic arch flow. They required sign ificantly higher ventilatory support (p = 0.01) and tended to need more ino tropic support. Reverse aortic arch flow in newborn infants with pulmonary hypertension, and no other cause for the reverse flow, indicates significan tly decreased left ventricular output, and may be a marker for a more diffi cult clinical course and poor prognosis. In this group of patients with pul monary hypertension, the survival was significantly higher in infants with no PDA or with pure left to right shunt across a PDA.