Journal ArticleDOI
Recommendations for utilization of the paracorporeal lung assist device in neonates and young children with pulmonary hypertension.
Avihu Z. Gazit,Stuart C. Sweet,R. Mark Grady,Umar S. Boston,Charles B. Huddleston,David M. Hoganson,Mark Shepard,Steve Raithel,Mary Mehegan,Allan Doctor,Philip C. Spinella,Pirooz Eghtesady +11 more
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TLDR
Four small children with refractory PH from ECMO to a device comprising an oxygenator interposed between the PA and LA, with emphasis on exclusion criteria, the implantation procedure, and the post‐implantation management are described.Abstract:
The management of decompensating critically ill children with severe PH is extremely challenging and requires a multidisciplinary approach. Unfortunately, even with optimal care, these children might continue to deteriorate and develop inadequate systemic perfusion and at times cardiac arrest secondary to a pulmonary hypertensive crisis. Tools to support these children are limited, and at times, the team should proceed with offering extracorporeal support, especially in newly diagnosed patients who have not benefitted from medical therapy prior to their acute deterioration, in patients with severe pulmonary venous disease and in patients with alveolar capillary dysplasia. Currently, the only approved mode for extracorporeal support in pediatric patients with PH eligible for lung transplantation is ECMO. To decrease the risks associated with ECMO, and offer potential for increased duration of support, extubation, and rehabilitation, we transitioned four small children with refractory PH from ECMO to a device comprising an oxygenator interposed between the PA and LA. This work describes in great detail our experience with this mode of support with emphasis on exclusion criteria, the implantation procedure, and the post-implantation management.read more
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Journal ArticleDOI
Pulmonary vein stenosis: Treatment and challenges
Journal ArticleDOI
Extracorporeal Membrane Oxygenation for Severe Pediatric Respiratory Failure.
TL;DR: Decisions to proceed with ECMO and the concomitant risk of potential life-threatening complications must consider multiple factors that balance potential risks and likelihood of benefit, pre-morbid conditions and impact on potential post-ECMO quality of life, candidacy for lung transplantation, and patient and family goals of care.
Journal ArticleDOI
Pulmonary-to-Systemic Arterial Shunt to Treat Children With Severe Pulmonary Hypertension
R. Mark Grady,Matthew W. Canter,Fei Wan,Anton A Shmalts,Ryan D. Coleman,Maurice Beghetti,Rolf M. F. Berger,Maria J Del Cerro Marin,Scott E. Fletcher,Russel Hirsch,Tilman Humpl,D. Dunbar Ivy,Edward C. Kirkpatrick,Thomas J. Kulik,Marilyne Lévy,Shahin Moledina,Delphine Yung,Pirooz Eghtesady,Damien Bonnet +18 more
TL;DR: In this article, the placement of a pulmonary-to-systemic arterial shunt in children with severe pulmonary hypertension (PH) has been demonstrated, in relatively small studies, to be an effective palliation for their disease.
Journal ArticleDOI
State of the Art in Pediatric Lung Transplantation
TL;DR: The current state of the art in pediatric lung transplantation is assessed, reviewing progress made to date and further opportunities to improve care for this unique group of patients.
Journal ArticleDOI
Pediatric lung transplantation
TL;DR: This review will discuss the historical aspects of pediatric lung transplantation, the current indications for transplant and the referral and listing process, and the current state of lung assist devices as a bridge to pediatric Lung transplantation.
References
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Journal ArticleDOI
Long-Term Intravenous Epoprostenol Infusion in Primary Pulmonary Hypertension Prognostic Factors and Survival
Olivier Sitbon,Marc Humbert,Hilario Nunes,Florence Parent,Gilles Garcia,Philippe Hervé,Maurizio Rainisio,G.érald Simonneau +7 more
TL;DR: It is suggested that lung transplantation should be considered in a subset of patients who remain in NYHA functional class III or IV or in those who cannot achieve a significant hemodynamic improvement after three months of epoprostenol therapy, or both.
Journal ArticleDOI
Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension?: A meta-analysis of 22 randomized trials
Gianluigi Savarese,Stefania Paolillo,Pierluigi Costanzo,Carmen D'Amore,Milena Cecere,Teresa Losco,Francesca Musella,Paola Gargiulo,Caterina Marciano,Pasquale Perrone-Filardi +9 more
TL;DR: In patients with PAH, improvement in 6MWD does not reflect benefit in clinical outcomes, and a meta-analysis performed to assess the influence of treatment on outcomes found no relationship between 6 MWD changes and outcomes.
Journal ArticleDOI
Reversibility of fixed pulmonary hypertension in left ventricular assist device support recipients.
Elisa Mikus,Alexander Stepanenko,Thomas Krabatsch,Antonio Loforte,Michael Dandel,Hans B. Lehmkuhl,Roland Hetzer,Evgenij V. Potapov +7 more
TL;DR: The data suggest that 6 months after LVAD implantation it is possible to observe an important reduction of PH and evaluate the potential transplantability of patients, and longer support does not add any effect of LVAD on PH.
Journal ArticleDOI
Neonatal mortality following transfusion of red cells with high plasma potassium levels
TL;DR: The death of a neonatal infant following cardiac surgery and the transfusion of packed red cells (RBCs) with high plasma potassium levels is reported, and it is concluded that the transfusions of relatively large volumes of RBCs be limited to fresh packed R BCs or to packed RBCS that have been saline washed, to minimize the complications of electrolyte disturbances.
Journal ArticleDOI
Lung transplantation for severe pulmonary hypertension--awake extracorporeal membrane oxygenation for postoperative left ventricular remodelling.
Igor Tudorache,Wiebke Sommer,Christian Kühn,Olaf Wiesner,Johannes Hadem,Thomas Fühner,Fabio Ius,Murat Avsar,Nicolaus Schwerk,Dietmar Böthig,Jens Gottlieb,Tobias Welte,Christoph Bara,Axel Haverich,Marius M. Hoeper,Gregor Warnecke +15 more
TL;DR: It is hypothesized that left ventricular (LV) dysfunction is the main cause of early postoperative morbidity or mortality and a weaning strategy using awake venoarterial extracorporeal membrane oxygenation (ECMO).