ECMO Support for Adults With Congenital Heart Disease

Survival of patients with congenital heart disease (CHD) is improving with advancements in medical care, surgery, critical care, and therapeutic intervention. Increasing numbers will present with acute deterioration that is amenable to extracorporeal life support (ECLS). This may be as a bridge to recovery or bridge to further definitive treatment, such as palliative surgery or heart transplantation. Adult congenital heart disease (ACHD) patients commonly present with right-sided heart problems either when functioning as a systemic ventricle or as a pulmonary ventricle. This chapter presents a patient with Ebstein anomaly as the stem case and discuss basic anatomical changes, classification of the anomaly, associated abnormalities, clinical presentation at different stages, progress, and general management. Specific problems associated with the use of ECLS in the ACHD subgroup, indications for commencing ECLS, sites for cannulation, control of anticoagulation, specifics of monitoring, critical care management, and common complications and their management are reviewed. Critical care board-type, multiple-choice questions summarize this chapter as a concise learning and study tool for the management of ACHD patients requiring ECLS.