[Total abnormal pulmonary venous return. Preoperative stabilization by extracorporeal veno-venous circulation].
BACKGROUND
Total anomalous pulmonary venous return (TAPVR) is a rare congenital cardiac disease. When this includes pulmonary artery hypertension, the infant is severely ill. Survival beyond infancy is rare without surgical correction.


METHODS
A girl in whom hydramnios and a short femur were discovered by ultrasonography at the 25th week of gestation was admitted to the intensive care unit a few hours after birth because of respiratory distress. Blood PaO2 was 37 mmHg, PaCO2, 36 mmHg, and pH 7.25. She had tachycardia (190/min) and circulatory insufficiency. Echocardiography showed right ventricular overload, a right-to-left shunt through a patent ductus arteriosus and foramen ovale and tricuspid insufficiency. This refractory hypoxemia was not corrected by conventional respiratory support, high-frequency oscillation plus dobutamine and dopamine followed by noradrenaline infusion. Because of further deterioration, the baby was given extracorporeal lung support; this rapidly improved the respiratory and hemodynamic conditions. Persistent pulmonary artery hypertension led to a second investigation that showed TAPVR She underwent emergency surgery.


CONCLUSIONS
Extracorporeal lung support can stabilize a precarious state in a case of severe congenital cardiac disease, so allowing surgical treatment under satisfactory conditions.
Casadevall
I
I
Service de Réanimation Pédiatrique Polyvalente, Hôpital Robert-Debré, Paris.
Germain
J F
JF
Kazandjian
V
V
Casasoprana
A
A
Desplanques
L
L
Laborde
F
F
Azancot
A
A
Maury
I
I
Beaufils
F
F
D004630:Emergencies; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000601:surgery*; D011300:Preoperative Care; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery
Retour veineux pulmonaire anormal total. Stabilisation préopératoire par circulation extra-corporelle veino-veineuse.