日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

The patient was a 33-year-old female who had undergone the Fontan procedure at 12 years for pulmonary atresia with a double-outlet right ventricle. She was working as a nurse at a medical office. She noticed general fatigue and dyspnea 2 days prior to admission. Although she took cefcapene pivoxil, she developed dyspnea and was admitted to Yamagata university hospital after a visit to the emergency unit at night. She was alert, and had a severe, productive cough. She was subsequently diagnosed with lobar pneumonia that required intensive care. She progressed to septic shock a few hours after admission. Although treatment for septic shock was initiated, her condition deteriorated because of arrhythmia, and she required mechanical ventilation. Three days after admission, venoarterial extracorporeal membrane oxygenation (VA ECMO) was initiated for circulatory failure, which had been refractory to the escalation of inotropic support, fluid resuscitation, corticosteroids and inhaled nitric oxide. Both blood and sputum cultures revealed the presence of Pseudomonas aeruginosa, and she was diagnosed with P. aeruginosa community-acquired pneumonia and sepsis. With intensive treatment, her cardiac function gradually stabilized, and she was diagnosed with septic cardiomyopathy. She was decannulated from ECMO on day 14 after admission, and was discharged on day 54. Brain CT before discharge revealed no findings of hypoxia or hypoperfusion. This is the first report of the successful treatment of P. aeruginosa community-acquired pneumonia and septic shock using VA ECMO after previous Fontan procedure.