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Venovenous perfusion in ECMO for new born respiratory insufficiency: A clinical comparison with venoarterial perfusion
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INTERNATIONAL ABSTRACTS THORAX
Digestive Duplication and Bronchogenic Cysts Compressing Trachea and S t e m Bronchi. P. Balquet. Chir P&tiatr 25:270-278,
(July), 1984. The author reports 29 cases of obstructive mediastinal cysts (21 bronchogenic cysts and 8 enteric duplications). Eleven were located on the carina. Five had neonatal symptoms but only one was treated early. Various types of imaging investigations are discussed, and the value of postero-anterior X-ray and bronchoscopy for early diagnosis is outlined. Surgery was always indicated and performed by thoracotomy in 24 cases, cervicotomy 3 cases, and sternotomy in 2 cases. Mean follow-up is 7 years, and only one postoperative death by severe tracheomalacia is reported.--J.M. Guys Broncho-Tracheal Compression by Mediastinal Congenital Tumors. J.P. Chappuis. Chir P6diatr 25:279-283, (July), 1984.
Twenty one cases of congenital cervico-mediastinal tumors with respiratory distress are reported (seven cystic hygromas, four hemangiomas, eight teratomas, and two thymic cysts). Respiratory distress was observed in 44% of patients with congenital tumors and more often below the age of 2. Etiology of the distress is discussed. Tracheal compression occurs in cystic hygromas and teratomas and tracheal invasion in hemangioma. The author emphasizes the value of primary ORL examination in emergency cases. Thirteen thoracotomies and six cervicotomies were performed. Postoperative respiratory distress was frequent due to tracheomalacia, nerve lesions, and recurrence. Seven deaths are reported, and the author discusses the poor prognosis of these benign tumors.--J.M. Guys Congenital Obstructive Emphysema of the Left Lung Associated with a Mediastinal Lymphatic Cyst. D.W.K. Man, S.T. Donne/l, F.
Raafat, et al. Thorax 39:211-212, (March), 1984. This case report concerns the successful left pneumonectomy with excision of mediastinal cyst performed on a newborn infant weighing 3.36kg.--J.F.R. Bentley Pleurectomy in e Ten Week old Child to Control Staphylococcala s s o c i a t e d Pneumothoraces. S. Large, J. Warner, and P. Gold-
straw. Thorax 39:157-158, (February), 1984. This case report concerns an infant who experienced 6 recurrent life-threatening pyopneumothoraces in 33 days ultimately controlled by pleurodesis.--J.F.R. Bentley Chest Tube Perforation of the Lungs in Premature Infants: Radiographic Recognition. J.L. Strife, P. Smith, J.S. Dunbar, et al. Am J
respiratory failure resistant to current medical and surgical management. This has the advantage of cardiac as well as pulmonary support. VA perfusion has certain disadvantages. Any air bubbles or particles in the system are perfused directly into the arterial system, and the carotid artery must be ligated. Venovenous (VV) perfusion ECMO does not require carotid artery ligation and obviates the problem of arterial embolization. Venovenous ECMO was utilized in 11 newborns with respiratory failure and compared with 16 patients treated during the same period with VA ECMO. Three of the l 1 VV patients required conversion to VA ECMO because of inadequate oxygenation and unstable hemodynamic situations. Ten of the 11 VV patients survived. Eleven of the VA patients survived. The better survival in the VV patients was attributed to a more favorable initial condition. Although VV ECMO supported survival in newborn infants with respiratory failure, there were no significant advantages over VA ECMO. Venovenous ECMO has the disadvantage of requiring ligation of the femoral vein with the known long term complications of venous insufficiency. In addition, the added groin dissection increases the time required per cannulation, and several patients had to be converted from VV ECMO to VA ECMO. The authors recommend the continued use of VA ECMO for routine clinical practice at the present time.--Richard J. Andrassy HEART A N D GREAT VESSELS An Alternative Method for Repair of Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava. H.E. Warden, R.A.
Gustafson, T.J. Tarnay, et al. Ann Thorac Surg 38:601-605, (DeCember), 1984. Fifteen patients with partial anomalous venous return to the high superior vena cava (less than 1 cm above the cavoatrial junction) underwent repair using a technique intended to avoid the postoperative sequelae seen with other types of repair. The technique involves anastomosis of the superior vena cava to the atrial appendage with the distal vena cava being oversewn. The sinus venosus defect is then closed by coaptation of the intracardiac orifice of the superior vena cava to the defect with a continuous suture. The defect can be enlarged to approximate the size of the vena cava. The only death in the series was secondary to severe pulmonary hypertension. One patient developed thrombosis of the cavoatrial anastomosis because adequate removal of trabeculae in the auricle was not accomplished at the original operation. This required reoperation and pericardial patch angioplasty. The remaining 13 patients have remained asymptomatic. Three developed post-operative electrocardiographic changes, but none have required pacemaker implantation. The preliminary data on this technique compares favorably with other methods of repair of partial anomalous venous return.--M. Reynolds
Roentgenol 141:73 75, (July), 1983. This paper reviews seven premature infants found to have perforation of lung parenchyma by a chest tube at postmortem examination. The authors feel, after a retrospective review, that recurrent or persistent pneumothorax after closed tube thoracostomy or infiltrates or densities at the tip of.a chest tube suggest this complication. Five of 7 infants exhibited the former and 4 of 7 the latter.--Randall W. Powell Venovenous Perfusion in ECMO For New Born Respiratory Insufficiency: A Clinical Comparison With Venoarterial Perfusion. M.D.
Klein, A.F. Andrews, J.l. Wesley, et al. Ann Surg 201:520-526, (April), 1985. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has proven successful in the treatment of newborns with
Results of the Damus-StanseI-Kaye Procedure for Transposition of the Great Arteries and for Double Outlet Right Ventricle with Subpuimonary Ventricular Septal Defect. E.L. Ceitharnl, F.J.
Puga, G.K. Danielson, et al. Ann Thorac Surg 38:433-437, (November), 1984. Conventional correction of transposition of the great arteries and of double outlet right ventricle with subpulmonary ventricular septal defect has been by transposition of venous return at the atrial level. Short and long-term complications of these procedures have prompted investigations for repair at the arterial level. In 20 patients with complete transposition of the great arteries and in 4 with double outlet right ventricle and subpulmonic ventricular septal defect, the Damus-Stansel-Kaye procedure was performed. Risk factors identified were age less than 18 months, weight less than 10 kg, and left ventricular peak systolic pressure less than 75% of systemic pressure.
INTERNATIONAL ABSTRACTS THORAX
Digestive Duplication and Bronchogenic Cysts Compressing Trachea and S t e m Bronchi. P. Balquet. Chir P&tiatr 25:270-278,
(July), 1984. The author reports 29 cases of obstructive mediastinal cysts (21 bronchogenic cysts and 8 enteric duplications). Eleven were located on the carina. Five had neonatal symptoms but only one was treated early. Various types of imaging investigations are discussed, and the value of postero-anterior X-ray and bronchoscopy for early diagnosis is outlined. Surgery was always indicated and performed by thoracotomy in 24 cases, cervicotomy 3 cases, and sternotomy in 2 cases. Mean follow-up is 7 years, and only one postoperative death by severe tracheomalacia is reported.--J.M. Guys Broncho-Tracheal Compression by Mediastinal Congenital Tumors. J.P. Chappuis. Chir P6diatr 25:279-283, (July), 1984.
Twenty one cases of congenital cervico-mediastinal tumors with respiratory distress are reported (seven cystic hygromas, four hemangiomas, eight teratomas, and two thymic cysts). Respiratory distress was observed in 44% of patients with congenital tumors and more often below the age of 2. Etiology of the distress is discussed. Tracheal compression occurs in cystic hygromas and teratomas and tracheal invasion in hemangioma. The author emphasizes the value of primary ORL examination in emergency cases. Thirteen thoracotomies and six cervicotomies were performed. Postoperative respiratory distress was frequent due to tracheomalacia, nerve lesions, and recurrence. Seven deaths are reported, and the author discusses the poor prognosis of these benign tumors.--J.M. Guys Congenital Obstructive Emphysema of the Left Lung Associated with a Mediastinal Lymphatic Cyst. D.W.K. Man, S.T. Donne/l, F.
Raafat, et al. Thorax 39:211-212, (March), 1984. This case report concerns the successful left pneumonectomy with excision of mediastinal cyst performed on a newborn infant weighing 3.36kg.--J.F.R. Bentley Pleurectomy in e Ten Week old Child to Control Staphylococcala s s o c i a t e d Pneumothoraces. S. Large, J. Warner, and P. Gold-
straw. Thorax 39:157-158, (February), 1984. This case report concerns an infant who experienced 6 recurrent life-threatening pyopneumothoraces in 33 days ultimately controlled by pleurodesis.--J.F.R. Bentley Chest Tube Perforation of the Lungs in Premature Infants: Radiographic Recognition. J.L. Strife, P. Smith, J.S. Dunbar, et al. Am J
respiratory failure resistant to current medical and surgical management. This has the advantage of cardiac as well as pulmonary support. VA perfusion has certain disadvantages. Any air bubbles or particles in the system are perfused directly into the arterial system, and the carotid artery must be ligated. Venovenous (VV) perfusion ECMO does not require carotid artery ligation and obviates the problem of arterial embolization. Venovenous ECMO was utilized in 11 newborns with respiratory failure and compared with 16 patients treated during the same period with VA ECMO. Three of the l 1 VV patients required conversion to VA ECMO because of inadequate oxygenation and unstable hemodynamic situations. Ten of the 11 VV patients survived. Eleven of the VA patients survived. The better survival in the VV patients was attributed to a more favorable initial condition. Although VV ECMO supported survival in newborn infants with respiratory failure, there were no significant advantages over VA ECMO. Venovenous ECMO has the disadvantage of requiring ligation of the femoral vein with the known long term complications of venous insufficiency. In addition, the added groin dissection increases the time required per cannulation, and several patients had to be converted from VV ECMO to VA ECMO. The authors recommend the continued use of VA ECMO for routine clinical practice at the present time.--Richard J. Andrassy HEART A N D GREAT VESSELS An Alternative Method for Repair of Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava. H.E. Warden, R.A.
Gustafson, T.J. Tarnay, et al. Ann Thorac Surg 38:601-605, (DeCember), 1984. Fifteen patients with partial anomalous venous return to the high superior vena cava (less than 1 cm above the cavoatrial junction) underwent repair using a technique intended to avoid the postoperative sequelae seen with other types of repair. The technique involves anastomosis of the superior vena cava to the atrial appendage with the distal vena cava being oversewn. The sinus venosus defect is then closed by coaptation of the intracardiac orifice of the superior vena cava to the defect with a continuous suture. The defect can be enlarged to approximate the size of the vena cava. The only death in the series was secondary to severe pulmonary hypertension. One patient developed thrombosis of the cavoatrial anastomosis because adequate removal of trabeculae in the auricle was not accomplished at the original operation. This required reoperation and pericardial patch angioplasty. The remaining 13 patients have remained asymptomatic. Three developed post-operative electrocardiographic changes, but none have required pacemaker implantation. The preliminary data on this technique compares favorably with other methods of repair of partial anomalous venous return.--M. Reynolds
Roentgenol 141:73 75, (July), 1983. This paper reviews seven premature infants found to have perforation of lung parenchyma by a chest tube at postmortem examination. The authors feel, after a retrospective review, that recurrent or persistent pneumothorax after closed tube thoracostomy or infiltrates or densities at the tip of.a chest tube suggest this complication. Five of 7 infants exhibited the former and 4 of 7 the latter.--Randall W. Powell Venovenous Perfusion in ECMO For New Born Respiratory Insufficiency: A Clinical Comparison With Venoarterial Perfusion. M.D.
Klein, A.F. Andrews, J.l. Wesley, et al. Ann Surg 201:520-526, (April), 1985. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) has proven successful in the treatment of newborns with
Results of the Damus-StanseI-Kaye Procedure for Transposition of the Great Arteries and for Double Outlet Right Ventricle with Subpuimonary Ventricular Septal Defect. E.L. Ceitharnl, F.J.
Puga, G.K. Danielson, et al. Ann Thorac Surg 38:433-437, (November), 1984. Conventional correction of transposition of the great arteries and of double outlet right ventricle with subpulmonary ventricular septal defect has been by transposition of venous return at the atrial level. Short and long-term complications of these procedures have prompted investigations for repair at the arterial level. In 20 patients with complete transposition of the great arteries and in 4 with double outlet right ventricle and subpulmonic ventricular septal defect, the Damus-Stansel-Kaye procedure was performed. Risk factors identified were age less than 18 months, weight less than 10 kg, and left ventricular peak systolic pressure less than 75% of systemic pressure.