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Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with low cardiac output and hypoxemia. We retrospectively evaluated the efficacy of ECMO support for respiratory and heart failure in infants and children. From April 2002 to February 2011, 14 patients aged 19 days to 20 years old (average 44 months), with body weight 2.6 kg to 71 kg (median 14.1 kg), underwent ECMO support for failing cardiac function, hypoxemia, and low cardiac output syndrome. In 12 patients, ECMO was introduced after operation for congenital heart disease (four with complete repair including Fontan circulation, and eight with palliative repair). In one patient, ECMO was introduced after partial pulmonary resection for congenital cystic adenomatoid malformation because of respiratory failure. ECMO was introduced in a patient with severe heart failure caused by fulminant myocarditis. Patients' demographics, duration of extracorporeal membrane oxygenation, additional support, and outcomes were analyzed. Ten patients (71%) were successfully weaned from ECMO, and eight patients (57%) were discharged from the hospital. The mean duration of ECMO support was 332 h (range 11-2030 h). Although management of the ECMO circuit, including anticoagulation (activated clotting time: 150-250), was conducted following the institutional practice guidelines, it was difficult to control the bleeding. Seven patients required renal replacement therapy during ECMO support using peritoneal dialysis or continuous hemodiafiltration. Five patients had additional operative procedures: systemic-pulmonary shunt in two, bidirectional Glenn takedown with right modified Blalock-Taussig shunt, total cavopulmonary connection takedown, and redo ECMO in one patient each. The patient who had the longest ECMO support for respiratory failure due to acute respiratory distress syndrome after lung surgery was successfully weaned from ECMO because high-frequency oscillation (HFO) improved respiratory function. ECMO for heart and respiratory failure in infants and children is effective and allows time for recovery of cardiac dysfunction and acute hypoxic insult. The long-term ECMO support for over 2000 h was very rare, but it was possible to wean this patient from ECMO using HFO.

Acute renal failure (ARF) after congenital cardiac surgery remains a serious complication and leading cause of morbidity and mortality. Continuous hemodiafiltration (CHDF) is presently accepted for pediatric applications. We retrospectively evaluated the effects of CHDF against ARF after congenital cardiac surgery at our hospital. We analyzed data from seven patients aged 23 days to 9 years and weighing 1.7-22.4 kg requiring dialysis therapy using CHDF after congenital cardiac surgery between April 2002 and January 2009. One patient who died could not be weaned from extracorporeal membrane oxygenation support and another died of multiple organ failure. Renal function recovered to normal in the other five (71%) patients. Treatment by CHDF lasted from 14 to 680 h and net ultrafiltration was 3.5 ± 1.4 mL/kg/h. Serum creatinine and urea concentrations were, respectively, 2.3 ± 1.6 and 43.7 ± 17.0 mg/dL before, and 0.5 ± 0.2 and 13.5 ± 8.1 mg/dL, after CHDF (P < 0.05). Thrombocytopenia developed in all patients, and platelet concentrates (0.76 ± 0.7 mL/kg/h) were infused during CHDF. Hypotension developed after changing the CHDF set in one patient. We suggest that CHDF is an effective alternative strategy for treating renal dysfunction after congenital cardiac surgery.

To clarify the flow pattern from a transventricular apical aortic cannula, hydrodynamic analysis of transventricular apical aortic cannulation (apical cannulation) was performed using particle-image velocimetry in a glass aortic model. Simulated apical cannulation using a 7-mm Sarns Soft-Flow cannula and the newly developed 7-mm apical aortic cannula was compared with standard aortic cannulation. The flow-velocity, streamline, and distribution of magnitude of the strain rate tensor (function of shear stress) were analyzed. Streamline analysis revealed a steady and organized flow profile in apical cannulation as compared with that in standard aortic cannulation. The magnitude of the strain rate tensor decreased within a few centimeters from the exit of the apical cannula.

Extracorporeal membrane oxygenation (ECMO) is widely used for circulatory support in pediatric cardiac patients with low cardiac output and hypoxemia. We retrospectively evaluated the efficacy of ECMO support for respiratory and heart failure in infants and children. From April 2002 to February 2011, 14 patients aged 19 days to 20 years old (average 44 months), with body weight 2.6 kg to 71 kg (median 14.1 kg), underwent ECMO support for failing cardiac function, hypoxemia, and low cardiac output syndrome. In 12 patients, ECMO was introduced after operation for congenital heart disease (four with complete repair including Fontan circulation, and eight with palliative repair). In one patient, ECMO was introduced after partial pulmonary resection for congenital cystic adenomatoid malformation because of respiratory failure. ECMO was introduced in a patient with severe heart failure caused by fulminant myocarditis. Patients' demographics, duration of extracorporeal membrane oxygenation, additional support, and outcomes were analyzed. Ten patients (71%) were successfully weaned from ECMO, and eight patients (57%) were discharged from the hospital. The mean duration of ECMO support was 332 h (range 11-2030 h). Although management of the ECMO circuit, including anticoagulation (activated clotting time: 150-250), was conducted following the institutional practice guidelines, it was difficult to control the bleeding. Seven patients required renal replacement therapy during ECMO support using peritoneal dialysis or continuous hemodiafiltration. Five patients had additional operative procedures: systemic-pulmonary shunt in two, bidirectional Glenn takedown with right modified Blalock-Taussig shunt, total cavopulmonary connection takedown, and redo ECMO in one patient each. The patient who had the longest ECMO support for respiratory failure due to acute respiratory distress syndrome after lung surgery was successfully weaned from ECMO because high-frequency oscillation (HFO) improved respiratory function. ECMO for heart and respiratory failure in infants and children is effective and allows time for recovery of cardiac dysfunction and acute hypoxic insult. The long-term ECMO support for over 2000 h was very rare, but it was possible to wean this patient from ECMO using HFO.

Acute renal failure (ARF) after congenital cardiac surgery remains a serious complication and leading cause of morbidity and mortality. Continuous hemodiafiltration (CHDF) is presently accepted for pediatric applications. We retrospectively evaluated the effects of CHDF against ARF after congenital cardiac surgery at our hospital. We analyzed data from seven patients aged 23 days to 9 years and weighing 1.7-22.4 kg requiring dialysis therapy using CHDF after congenital cardiac surgery between April 2002 and January 2009. One patient who died could not be weaned from extracorporeal membrane oxygenation support and another died of multiple organ failure. Renal function recovered to normal in the other five (71%) patients. Treatment by CHDF lasted from 14 to 680 h and net ultrafiltration was 3.5 ± 1.4 mL/kg/h. Serum creatinine and urea concentrations were, respectively, 2.3 ± 1.6 and 43.7 ± 17.0 mg/dL before, and 0.5 ± 0.2 and 13.5 ± 8.1 mg/dL, after CHDF (P0.05). Thrombocytopenia developed in all patients, and platelet concentrates (0.76 ± 0.7 mL/kg/h) were infused during CHDF. Hypotension developed after changing the CHDF set in one patient. We suggest that CHDF is an effective alternative strategy for treating renal dysfunction after congenital cardiac surgery.

To clarify the flow pattern from a transventricular apical aortic cannula, hydrodynamic analysis of transventricular apical aortic cannulation (apical cannulation) was performed using particle-image velocimetry in a glass aortic model. Simulated apical cannulation using a 7-mm Sarns Soft-Flow cannula and the newly developed 7-mm apical aortic cannula was compared with standard aortic cannulation. The flow-velocity, streamline, and distribution of magnitude of the strain rate tensor (function of shear stress) were analyzed. Streamline analysis revealed a steady and organized flow profile in apical cannulation as compared with that in standard aortic cannulation. The magnitude of the strain rate tensor decreased within a few centimeters from the exit of the apical cannula.