ECMO support for late presenting arterial switch operation; case report and review of literature

Infants presenting for late arterial switch operation are at risk of myocardial depression and cardiac arrest due left ventricle deconditioning. In this report we present a female infant diagnosed to have transposition of great arteries (TGA) with intact septum who presented at 3 months of age for late arterial switch operation. Prior to surgery, the left ventricle size and mass index appeared to be satisfactory in term of muscular size and function. She underwent late arterial switch operation (ASO). Soon after surgery, the infant developed myocardial depression with hemodynamic instability and high left atrial pressure associated with left atrial dilatation. ECMO was deployed and patient stayed 10 days on ECMO until left cardiac function recovered. The infant was decannulated successfully and was subsequently discharged home with acceptable cardiac function. In conclusion, patients presenting for late arterial switch operation are at risk for left ventricular deconditioning and pulmonary hypertension. Deconditioned left ventricle may fail post repair with inability to handle systemic circulation. Among limited options for these challenging cases primary ASO with integrated ECMO support can be used to allow deconditioned left ventricle to recover its function and ability to handle systemic circulation.