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The Use of Veno-Venous Extracorporeal Membrane Oxygenation for Perinatal Support of an Infant with D-Transposition of the Great Arteries, Intact Atrial and Ventricular Septa, and Flow-Restricted Ductus Arteriosus

Sullivan, Kevin J. MD; Lacey, Stephanie R. DO; Schrum, Stefanie F. MD; Freid, Eugene B. MD; Collins, Steve V. MD; Bouchard, Amy R. DO; Burns, Scott E. MD; Poulos, Nicholas D. MD; Walsh, Danielle S. MD; Ingyinn, Ma MD; Ettedgui, Jose A. MD; Ceithaml, Eric L. MD; Jerabek, Charles F. CCP; Herald, Tammy S. RN, RRT; Castillo, Ramon A. MD; Trogolo, Frank MD; Bleiweis, Mark S. MD; Hudak, Mark L. MD

doi: 10.1213/XAA.0000000000000022
Case Reports: Case Report

Prenatal assessment of a fetus with D-transposition of the great arteries demonstrated an absence of mixing between systemic and pulmonary circulations, and predicted lethal postnatal hypoxemia. A multidisciplinary meeting evaluated therapeutic options. After cesarean delivery, veno-venous extracorporeal membrane oxygenation was instituted in preparation for open atrial septectomy. The infant subsequently underwent an arterial switch procedure. Prenatal delineation of pulmonary and systemic circulations in the fetus with D-transposition of the great arteries influences postnatal management. Multidisciplinary planning enhanced the perinatal outcome.

From the *Department of Pediatric Anesthesia and Critical Care Medicine, Nemours Children’s Clinic, Jacksonville, Florida; Department of Anesthesia, Mayo School of Medicine, Rochester, Minnesota, Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Florida College of Medicine, Jacksonville, Florida; §Wolfson Children’s Hospital, Jacksonville, Florida; Department of Pediatrics, Division of Pediatric Cardiology, University of Florida College of Medicine, Jacksonville, Florida, JLR Medical Group and Florida Hospital for Children, Orlando, Florida, and Affiliated Professor of Anesthesiology, University of Central Florida, Orlando, Florida; #Department of Anesthesiology, University of Connecticut, Hartford, Connecticut; **Associated Anesthesiologists Inc., St. Francis Hospital, Tulsa, Oklahoma; ††Department of Pediatric Surgery, Nemours Children’s Clinic, Jacksonville, Florida; ‡‡Department of Extracorporeal Membrane Oxygenation, Wolfson Children’s Hospital, Jacksonville, Florida; §§Department of Surgery, Division of Pediatric Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina; ‖‖Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, Jacksonville, Florida; ¶¶Congenital Heart Center and Division of Pediatric Cardiothoracic Surgery, University of Florida College of Medicine, Gainesville, Florida; ##Department of Perfusion Services, Wolfson Children’s Hospital, Jacksonville, Florida; ***Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, Florida; †††Department of Obstetrics and Gynecology, Baptist Medical Center, Jacksonville, Florida; and ‡‡‡Department of Obstetrics and Gynecology, North Florida Obstetrics and Gynecology, Jacksonville, Florida.

Accepted for publication December 23, 2013.

Funding: No funding was needed or requested.

The authors declare no conflicts of interest.

This report was previously presented, in part, at the Poster Presentation at Society of Pediatric Anesthesia Meeting in Jacksonville, FL 3/2009.

Address correspondence to Kevin J. Sullivan, MD, Department of Pediatric Anesthesia and Critical Care Medicine, Wolfson Children’s Hospital and Nemours Children’s Clinic, 807 Children’s Way, Jacksonville, FL 32207. Address e-mail to klsullijax@aol.com.

© 2014 International Anesthesia Research Society