PMID- 17672195
OWN - NLM
STAT- MEDLINE
DCOM- 20071016
LR  - 20201209
IS  - 0022-1058 (Print)
IS  - 0022-1058 (Linking)
VI  - 39
IP  - 2
DP  - 2007 Jun
TI  - Extracorporeal membrane oxygenation in severe acute respiratory failure in 
      postpartum woman with rheumatic mitral valve disease: benefit, factors furthering 
      the success of this procedure, and review of the literature.
PG  - 112-6
AB  - Pregnancy is a common decompensation factor for women with post-rheumatic mitral 
      disease. However, valvular heart diseases causing severe acute respiratory 
      distress are rare. Use of extracorporeal membrane oxygenation (ECMO) early in the 
      event of cardiorespiratory failure after cardiac surgery may be of benefit. 
      Indeed, ECMO cardiopulmonary bypass (CPB) support could help pulmonary recovery 
      if the mitral pathology is involved. A 31-year-old female patient at 30 weeks of 
      amenorrhea was admitted to the obstetrics department with 40 degrees C 
      hyperthermia and New York Heart Association (NYHA) class 4 dyspnea. The patient's 
      medical history included a post-rheumatic mitral stenosis. Blood gases showed 
      severe hypoxemia associated with hypocapnia. The patient needed to be rapidly 
      intubated and was placed on ventilatory support because of acute respiratory 
      failure. Transesophageal echocardiography showed a severe mitral stenosis, mild 
      mitral insufficiency, and diminished left ventricular function, hypokinetic, 
      dilated right ventricle, and a severe tricuspid regurgitation. An urgent cesarean 
      section was performed. Because of the persistent hemodynamic instability, a 
      mitral valvular replacement and tricuspid valve annuloplasty were performed. In 
      view of the preoperative acute respiratory distress, we decided, at the beginning 
      of the operation, to carry on circulatory support with oxygenation through an 
      ECMO-type CPB at the end of the operation. This decision was totally justified by 
      the unfeasible CPB weaning off. ECMO use led to an efficient hemodynamic state 
      without inotropic drug support. The surgical post-operative course was 
      uneventful. Early use of cardiorespiratory support with veno-arterial ECMO allows 
      pulmonary and right heart recovery after cardiac surgery, thus avoiding the use 
      of inotropic drugs and complex ventilatory support.
FAU - Fayad, Georges
AU  - Fayad G
AD  - Clinique de Chirurgie Cardiovasculaire, Hopital Cardiologique, CHRU de Lille, 
      France. g-fayad@chru-lille.fr
FAU - Larrue, Benoit
AU  - Larrue B
FAU - Modine, Thomas
AU  - Modine T
FAU - Azzaoui, Richard
AU  - Azzaoui R
FAU - Regnault, Alexi
AU  - Regnault A
FAU - Koussa, Mohammad
AU  - Koussa M
FAU - Gourlay, Terry
AU  - Gourlay T
FAU - Fourrier, Francois
AU  - Fourrier F
FAU - Decoene, Christophe
AU  - Decoene C
FAU - Warembourg, Henri
AU  - Warembourg H
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - France
TA  - J Extra Corpor Technol
JT  - The journal of extra-corporeal technology
JID - 0267637
MH  - Adult
MH  - *Cesarean Section
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Heart Valve Diseases/*complications
MH  - Humans
MH  - Hypocapnia
MH  - Hypoxia
MH  - Mitral Valve/pathology/*surgery
MH  - *Postoperative Complications
MH  - Postpartum Period
MH  - Pregnancy
MH  - *Pregnancy Complications
MH  - Respiratory Distress Syndrome/etiology/*therapy
MH  - Respiratory Insufficiency/etiology/*therapy
MH  - Rheumatic Heart Disease/*complications
MH  - Tricuspid Valve/*surgery
PMC - PMC4680664
COIS- The senior author has stated that authors have reported no material, financial or 
      other relationship with any healthcare-related business or other entity whose 
      products or services are discussed in this paper.
EDAT- 2007/08/04 09:00
MHDA- 2007/10/17 09:00
PMCR- 2007/12/01
CRDT- 2007/08/04 09:00
PHST- 2007/08/04 09:00 [pubmed]
PHST- 2007/10/17 09:00 [medline]
PHST- 2007/08/04 09:00 [entrez]
PHST- 2007/12/01 00:00 [pmc-release]
AID - ject.2007.39.2.112 [pii]
PST - ppublish
SO  - J Extra Corpor Technol. 2007 Jun;39(2):112-6.