Extracorporeal membrane oxygenation as a bridge to cardiac transplantation in a patient with cardiomyopathy and hemophilia A.
OBJECTIVE
To report the use of extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation in a patient with hemophilia A and dilated cardiomyopathy.


METHODS
Case report.


RESULTS
During ECMO factor VIII concentrate was administered to maintain a factor VIII level close to 50% of normal control both to decrease the risk of bleeding and to allow standard anticoagulation with heparin. The patient developed an inhibitor to exogenous factor VIII during hospitalization, which was successfully managed with a high-dose continuous infusion of factor VIII during ECMO, the transplant operation, and the postoperative period.


CONCLUSIONS
We report the successful use of ECMO as a bridge to cardiac transplantation in a patient with hemophilia A and low-level factor VIII inhibitors.
Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA. ravi@cardio.chboston.org.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA. ravi@cardio.chboston.org.
Ravi R
RR
Thiagarajan
Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Stephen J
SJ
Roth
Division of Hematology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Steven
S
Margossian
Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Andrew S
AS
Mackie
Division of Hematology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Ellis J
EJ
Neufeld
Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Peter C
PC
Laussen
Department of Cardiovascular Surgery, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Joseph M
JM
Forbess
Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA, 02115, USA.|Departments of Pediatrics and Surgery, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA.
Elizabeth D
ED
Blume
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001806:Blood Urea Nitrogen; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000628:therapy*; D002648:Child; D003404:Creatinine / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005169:Factor VIII / Q000378:metabolism / Q000627:therapeutic use; D016027:Heart Transplantation; D006467:Hemophilia A / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D014914:Whole Blood Coagulation Time
D005169:Factor VIII; D003404:Creatinine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase