Successful Use Of Venoartieral Extracorporeal Membrane Oxygenation As A Bridge To A Reverse Potts Shunt In A Patient With Pulmonary Hypertension
Constantine D. Mavroudis, MD, MSc, MTR, Madison A. Grasty, MD, MS, Trevor Williams, MD, Jennifer Tingo, MD, Jeremiah Joyce, MD, Katsuhide Maeda, MD, PhD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Objective: The reverse Potts shunt has emerged as a successful palliative treatment for severe pulmonary hypertension (PH). Preoperative extracorporeal membrane oxygenation (ECMO) is uniformly reported to result in mortality, questioning the utility of the Potts shunt among the sickest patients.
Methods: We present a 3 year old patient with generalized arterial calcinosis of infancy and severe PH, who presented with acute pulmonary hypertensive crisis secondary to viral infection requiring venoarterial ECMO. Following transfer to our center, attempts were made to wean ECMO support without success. He underwent Potts shunt after one week of ECMO support. Median sternotomy approach was employed in order to avoid lung injury by manipulation. Despite significant aortic and pulmonary arterial calcification on imaging, both vessels were partially clamped safely and a 10mm ringed polytetrafluroethylene conduit was sewn from the left pulmonary artery to the distal aortic arch. ECMO support was then weaned, there was equalization of right and left ventricular pressures and a 15% saturation differential in upper and lower extremities. Left atrial, right atrial and right ventricular pressure lines were placed intraoperatively and were instrumental in his postoperative management. He was discharged to home on postoperative day 63, on supplemental oxygen and triple agent therapy for PH.
Results: This case demonstrates that the Potts shunt can be employed even in patients requiring preoperative ECMO support.
Conclusions: Preoperative ECMO support and generalized arterial calcinosis may not be contraindications for Potts shunt placement in certain high risk pulmonary hypertension patients, and should be considered in select patients.
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