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J Thorac Cardiovasc Surg 2004;127:582-583
© 2004 The American Association for Thoracic Surgery

Brief communication

Rescue of a case of ventricular septal defect with Eisenmenger syndrome using an extracorporeal membrane oxygenator

^a Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
^b Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Received for publication August 29, 2003; accepted for publication October 10, 2003.

^* Address for reprints: Yih-Sharng Chen, MD, Department of Surgery, National Taiwan University Hospital, No 7, Chung-Shan S. Road, Taipei, Taiwan
yschen11@yahoo.com.tw

The first 20% of the full text of this article appears below.

Drs Yu and Chen

Eisenmenger syndrome with ventricular septal defect (VSD) complicated with acute deterioration is always fatal because no treatment modality is reported effective. The present article reports our experience to rescue such a case by modern therapeutic modalities.

Clinical summary

A 38-year-old male patient presented with severe respiratory distress. A large VSD with Eisenmenger syndrome had been diagnosed in the patient 2 years previously (Figure 1). A chest x-ray film revealed a pulmonary hemorrhage at the upper lobe of the right lung (Figure 2, A). The patient's arterial oxygen concentration was extremely low (68%) even with ventilator support of 100% oxygen. A venovenous extracorporeal membrane oxygenator (ECMO) was inserted through the left femoral vein (outflow from the patient) and right jugular vein (inflow to the patient) in an attempt to increase his oxygen saturation. Because of severe mixing of blood across the VSD,¹ the percutaneous saturation was still low (SpO₂ = 74%) even with the venovenous ECMO support. Intermittent bradycardia occurred during the support, which was considered to be the result of inadequate tissue oxygenation. It seemed critical to find a way to decrease the mixing of deoxygenated blood across the VSD to save the patient's life. Two days later, after a discussion with the patient's family, we decided to perform an operation to close the VSD and create an atrial septal . . . [Full Text of this Article]