Extracorporeal support for right ventricular failure following LVAD implantation in a 5-year-old child: a case report

Résumé fourni par la source

Introduction. Postoperative right ventricular failure is a dangerous adverse event in patients after left ventricular assist device (LVAD) implantation. The survival rate of such patients is extremely low. The only strategy that enables patient survival after LVAD implantation is the use of extracorporeal membrane oxygenation (ECMO) to bypass the right ventricle. The objective was to present a case report on the management of right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation in a 5-year-old child, utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a right ventricular bypass strategy. Results. Serial echocardiographic assessment under ECMO support revealed progressive RV functional recovery, with FAC increasing from 7% to 28% and TR decreasing from 50% to 15% by postoperative day 10. The patient was successfully weaned from ECMO on day 14 with preserved RV function (FAC 30%, grade 1 TR). Conclusion. The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a right ventricular bypass strategy provides hemodynamic stabilization, improves oxygenation, and creates optimal conditions for myocardial recovery. This case report demonstrates the efficacy of a gradual ECMO weaning protocol under echocardiographic guidance, which may prove valuable in managing similar clinical scenarios.

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