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Langseth MS, Nordstrand N, Erikssen G. Intra-aortic balloon pump treatment in an adult patient with a Fontan circulation and acute heart failure: a case report. Eur Heart J Case Rep 2024; 8:ytae289. [PMID: 38912116 PMCID: PMC11192165 DOI: 10.1093/ehjcr/ytae289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/05/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
Background There is limited evidence for the use of an intra-aortic balloon pump (IABP) in adult patients with a total cavopulmonary, or Fontan circulation. Case summary A patient in his twenties with a Fontan circulation presented with sepsis, pneumonia, and pulmonary oedema. He was born with a hypoplastic left ventricle, atrioventricular septal defect, and hypoplastic aortic arch, and a total cavopulmonary circulation had been established within his first years of life. Standard of care treatment with antibiotics, non-invasive ventilatory support, loop diuretics, and vasopressors was initiated. Due to persistent pulmonary congestion and increasing general fatigue, an IABP was placed via a femoral artery to offload the failing systemic ventricle. Secondary to IABP treatment, mean arterial pressure rose, and vasodilatory nitroprusside could be introduced. Over 4 days of IABP treatment, the patient's general condition and ventricular systolic function improved significantly. Discussion This case suggests that IABP treatment was important in the recovery of our patient with a Fontan circulation, pneumonia, and heart failure. We propose that during IABP treatment, an increase in stroke volume and a reduction in ventricular filling pressure is achieved, thereby increasing the transpulmonary pressure gradient that is central to pulmonary blood flow in Fontan patients. More definitive evidence is necessary to confirm our hypotheses.
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Affiliation(s)
- Miriam Sjåstad Langseth
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, PB 4956 Nydalen, 0424 Oslo, Norway
| | - Njord Nordstrand
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, PB 4956 Nydalen, 0424 Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, PB 4956 Nydalen, 0424 Oslo, Norway
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Kainuma A, Ning Y, Kurlansky PA, Wang AS, Axom K, Farr M, Sayer G, Uriel N, Naka Y, Takeda K. Changes in waitlist and posttransplant outcomes in patients with adult congenital heart disease after the new heart transplant allocation system. Clin Transplant 2021; 35:e14458. [PMID: 34398487 DOI: 10.1111/ctr.14458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In 2018, the United Network for Organ Sharing (UNOS) introduced new criteria for heart allocation. This study sought to assess the impact of this change on waitlist and posttransplant outcomes in adult congenital heart disease (ACHD) recipients. METHODS Between January 2010 and March 2020, we extracted first heart transplant ACHD patients listed from the UNOS database. We compared waitlist and post-transplant outcomes before and after the policy change. RESULTS A total of 1206 patients were listed, 951 under the old policy and 255 under the new policy. Prior to transplant, recipients under the new policy era were more likely to be treated with extracorporeal membrane oxygenation (P = .018), and have intra-aortic balloon pumps (P < .001), and less likely to have left ventricular assist devices (P = .027).Compared to patients waitlisted in the pre-policy change era, those waitlisted in the post policy change era were more likely to receive transplants (P = .001) with no significant difference in waiting list mortality (P = .267) or delisting (P = .915). There was no difference in 1-year survival post-transplant between the groups (P = .791). CONCLUSION The new policy altered the heart transplant cohort in the ACHD group, allowing them to receive transplants earlier with no changes in early outcomes after heart transplantation.
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Affiliation(s)
- Atsushi Kainuma
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University, New York, New York, USA
| | - Paul A Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Amy S Wang
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Kelly Axom
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Maryjane Farr
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Gabriel Sayer
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Nir Uriel
- Department of Medicine/Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Yoshifumi Naka
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Koji Takeda
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
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Sachdev A, Mehra B, Mohanty A, Gupta D, Gupta N. Refractory pediatric cardiogenic shock: A case for mechanical support. Indian J Crit Care Med 2016; 20:680-683. [PMID: 27994387 PMCID: PMC5144534 DOI: 10.4103/0972-5229.194012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute left ventricular dysfunction in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices, and the use of the intra-aortic balloon pump (IABP). The IABP is a commonly used method of temporary circulatory support in adults. However, despite the availability of pediatric size balloons, the usage of IABP for temporary circulatory support in children has not been widespread. Current case report, first from India in pediatric age group, aims to aware the pediatric intensivist about the role of IABP in providing temporary mechanical cardiovascular support in managing patients with refractory low cardiac output state.
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Affiliation(s)
- Anil Sachdev
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Bharat Mehra
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Mohanty
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Dhiren Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeraj Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
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Paul Collison S, Singh Dagar K. The role of the Intra-aortic balloon pump in supporting children with acute cardiac failure. Postgrad Med J 2007; 83:308-11. [PMID: 17488858 PMCID: PMC2600077 DOI: 10.1136/pgmj.2006.053611] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Acute heart failure occurs in children following the operative correction of a congenital anomaly, as an acute change in a child with a congenital anomaly, or in a structurally normal heart with acute myocarditis. Acute heart failure in children justifies aggressive treatment because of the high potential for complete recovery. The options for providing mechanical support to the failing heart in a child include extracorporeal membrane oxygenation, left ventricular assist devices and the use of the intra-aortic balloon pump (IABP). The principles of intra-aortic balloon pump usage are described, and the literature regarding the indications and outcome of its use in children is reviewed.
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Affiliation(s)
- Sathiakar Paul Collison
- Department of Pediatric and Congenital Heart Surgery, Escorts Heart Institute And Research Centre, New Delhi, India.
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Chowdhury UK, Kothari SS, Subramaniam GK. Intra-aortic balloon counterpulsation in a patient with the failing Fontan circulation. Cardiol Young 2007; 17:102-4. [PMID: 17184574 DOI: 10.1017/s1047951106001235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2006] [Indexed: 11/07/2022]
Abstract
We report a 23-year-old patient undergoing functionally univentricular repair who developed cardiac failure due primarily to systemic ventricular dysfunction. The failing Fontan circulation was successfully re-established using intra-aortic balloon counterpulsation. Aortic counterpulsation facilitates recovery of systemic ventricular function, and appears to be a reasonable alternative in select instances of cardiac failure in patients with the Fontan circulation.
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Affiliation(s)
- Ujjwal K Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
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Kalavrouziotis G, Karunaratne A, Raja S, Ciotti G, Purohit M, Corno AF, Pozzi M. Intra-aortic balloon pumping in children undergoing cardiac surgery: an update of the Liverpool experience. J Thorac Cardiovasc Surg 2006; 131:1382-1382.e10. [PMID: 16733173 DOI: 10.1016/j.jtcvs.2006.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 02/19/2006] [Accepted: 02/24/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intra-aortic balloon pumping in children remains a rarity. We report our experience in supporting pediatric cardiac surgical patients with intra-aortic balloon pumping. METHODS We reviewed the cases of 24 children supported with intra-aortic balloon pumping after cardiac surgery in our institution from 1994 through 2003. RESULTS Mean age at the time of the operation was 5.0 +/- 5.6 years (range, 7 days-17.5 years). Ten patients were infants less than 6 months old. Mean weight was 18.9 +/- 18.1 kg (range, 3.5-58.7 kg). Indications for intra-aortic balloon pump deployment were postoperative hemodynamic deterioration (n = 11, 8 survivors), failure to wean off cardiopu(n = 7, 5 survivors), and prophylaxis before weaning off cardiopulmonary bypass (n = 6, 5 survivors). The balloon was inserted through the ascending aorta in infants and through the femoral artery in children. Eighteen children (7 infants) were weaned off the intra-aortic balloon pump successfully (intra-aortic balloon pump survival, 75%). Mean duration of intra-aortic balloon pump support was 121.3 +/- 140.60 hours (range, 8-670 hours). There were 3 post-intra-aortic balloon pump in-hospital deaths (survival to hospital discharge, 62.5%). Severe intra-aortic balloon pump-related complications were mesenteric ischemia in 1 patient and lower limb ischemia requiring intra-aortic balloon pump removal in 1 patient. At a mean follow-up of 85 +/- 31 months (range, 18-124 months), all 15 long-term survivors were alive and well. CONCLUSIONS Use of an intra-aortic balloon pump is an effective modality of cardiac support in properly selected pediatric cardiac surgical patients with refractory low cardiac output. It can be safely used in small infants and neonates. In selected cases with known left ventricular dysfunction, there is a place for prophylactic use of an intra-aortic balloon pump.
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Affiliation(s)
- Georgios Kalavrouziotis
- Department of Pediatric Cardio-Thoracic Surgery, Royal Liverpool Children's NHS Trust, Alder Hey Hospital, Liverpool, United Kingdom.
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Pinkney KA, Minich LL, Tani LY, Di R, Veasy LG, McGough EC, Hawkins JA. Current results with intraaortic balloon pumping in infants and children. Ann Thorac Surg 2002; 73:887-91. [PMID: 11899196 DOI: 10.1016/s0003-4975(01)03563-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Intraaortic balloon pumping (IABP) is useful for support in patients with moderate left ventricular dysfunction. IABP is usually timed with the R wave of the electrocardiogram. We have utilized M-mode echocardiography timed IABP in children with left-side heart failure since 1994. Electrocardiogram timing seems inappropriate for children, who have much higher heart rates. We describe our experience with children who underwent IABP therapy before and after 1994, when echocardiographic timing was instituted. METHODS We reviewed records of 29 children who underwent IABP for all indications at Primary Children's Medical Center since 1988. RESULTS Overall survival was 62.1% (18 of 29) in this series. Survival was similar for infants (odds ratio = 2.0, 95% confidence interval = 0.29 to 14.31, p = 0.43) and older children. Survival was similar in the echocardiography era when compared with the electrocardiogram era (odds ratio = 2.4, 95% confidence interval = 0.56 to 10.4, p = 0.44). CONCLUSIONS IABP is a useful means of support in children with left ventricular dysfunction. M-mode echocardiography is effective in triggering IABP. The sample size in this study is too small to detect a mortality rate difference.
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Affiliation(s)
- Kerrie A Pinkney
- Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City 84113, USA
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Schure AY, Laussen PC, McGowan FX. Mechanical Cardiopulmonary Support of Infants and Children With Congenital Heart Disease. Semin Cardiothorac Vasc Anesth 2001. [DOI: 10.1053/scva.2001.21577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac indications for the use of mechanical cardiopulmo nary support techniques in infants and children include short-term circulatory support during reversible myocardial failure, cardiopulmonary support before and after cardiac surgery, and a bridge to cardiac transplantation. For practi cal purposes, 3 modalities are currently available for these patients: extracorporeal membrane oxygenation, use of ven tricular assist devices, and intra-aortic balloon pump coun terpulsation. Although a variety of devices are available for larger patients, the need for smaller sizes and a wider range of sizes has delayed their use in children. This article sum marizes the current systems available for children as well as indications and outcome data related to their use in infants and children with congenital or acquired heart disease. Copyright © 2001 by W.B. Saunders Company.
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Affiliation(s)
- Annette Y. Schure
- Department of Anesthesiology, Cardiac Anesthesia Service, Children's Hospital, and Harvard Medical School, Boston, MA
| | - Peter C. Laussen
- Department of Anesthesiology, Cardiac Anesthesia Service, Children's Hospital, and Harvard Medical School, Boston, MA
| | - Francis X. McGowan
- Department of Anesthesiology, Cardiac Anesthesia Service, Children's Hospital, and Harvard Medical School, Boston, MA
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