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

The Avalon Elite® bi-caval dual lumen catheter (Avalon DLC) enables veno-venous extracorporeal membrane oxygenation (V-V ECMO) with a single cannula. There are no reports of using this catheter in infants with congenital heart disease in Japan. We report a 3-month-old boy who weighed 3.5 kg and was diagnosed with Cantrell syndrome, tetralogy of Fallot, and persistent left superior vena cava. He underwent multistage abdominal wall closure, diaphragmatic suture, and tracheostomy for omphalocele, diaphragmatic hernia, and tracheomalacia. At 3 months of age, hypoxemia appeared and cardiac magnetic resonance imaging showed low pulmonary blood flow with a Qp/Qs ratio of 0.4, indicating the need for Blalock–Taussig shunt surgery. There was concern regarding postoperative mediastinitis because of the proximity of the abdominal wound and tracheostomy site to the sternum. Therefore, a left-sided thoracotomy was planned instead of a median sternotomy. However, compression of the lung on the operative side was expected to further worsen oxygenation, and we planned to introduce V-V ECMO before surgery. The right internal jugular vein was the only site where a cannula could be inserted percutaneously owing to the anatomical characteristics of the vessels. A 13 Fr Avalon DLC was inserted through the right internal jugular vein, and V-V ECMO was used to achieve good oxygenation. The Avalon DLC may be useful in infants with congenital heart disease and multiple malformations who require ECMO.