Recovery of lung function and resolution of pulmonary hemorrhage is possible in an infant on ECMO with extreme left atrial hypertension following left heart decompression and AV node ablation.
Left heart decompression and AV node ablation may permit pulmonary hemorrhage resolution in infants on ECMO with left atrial hypertension; single case leaves open broader applicability.
OBJECTIVE: We report here the survival of an infant who developed extreme left atrial hypertension and severe pulmonary hemorrhage while supported with extracorporeal membrane oxygenation for refractory atrial flutter. The patient recovered after decompression of the left heart and catheter ablation of the atrioventricular node. SETTING: Lucile Packard Children's Hospital (Stanford, CA). DATA SOURCE: Chart review. CONCLUSIONS: Recovery of lung function is possible despite systemic-level left atrial pressure resulting in pulmonary hemorrhage and complete solidification of lung parenchyma on gross inspection. Resolution of pulmonary hemorrhage despite anticoagulation while on extracorporeal membrane oxygenation can occur after relief of left atrial hypertension.
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Cisco et al. (2010) studied this question.
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