ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Single-ventricle palliation without the use of cardiopulmonary bypass carries advantages that reduce systemic edema and inflammatory responses; however, simple clamping of the superior vena cava (SVC) without a temporary shunt leads to increase in cerebral venous pressure and subsequent decrease in cerebral blood flow during bidirectional cavopulmonary shunt (BCPS). We report our experience of BCPS, using a centrifugal pump-assisted temporary shunt. The criteria included an unrestrictive interatrial communication, the absence of atrioventricular valve regurgitation, and the existence of an antegrade pulmonary blood flow. ⋯ No patients required blood transfusion. There were no postoperative neurological complications. The centrifugal pump-assisted temporary shunt offered safer and more effective circulatory support than other shunt systems, with excellent venous drainage in pediatric patients undergoing BCPS.
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Since recirculation during venovenous extracorporeal membrane oxygenation (VV ECMO) reduces oxygen delivery to the patient, monitoring recirculation is necessary to guide clinicians in interventions that may reduce recirculation and thereby optimize patient care. The use of dilutional ultrasound may be a clinically practical way to quantify recirculation during VV ECMO. This study evaluates in a swine model of VV ECMO a dilutional ultrasound techniques ability to provide accurate recirculation data under changing conditions. ⋯ The time for results was much faster with the use of dilutional ultrasound. Induction of recirculation changes by repositioning the cannula or changing cardiac output was rapidly detected using dilutional ultrasound and showed significant differences from baseline recirculation. Dilutional ultrasound provides a clinically practical method to quantify and monitor recirculation in VV ECMO applications and may aid in assessing interventions to improve oxygen delivery.