Cardiopulmonary bypass management methods of one stage repair of infant with aortic coarctation complicated with intracardiac malformation

Objective To evaluate the management methods and clinical effect of cardiopulmonary bypass on 27 infant with coarctation of aorta (COA) complicated with intracardiac malformation in our hospital bet een Jan 2005 and Nov 2011.Methods The 27 cases were operated under deep hypothermic circulatory arrest(DHCA) with end-to-end anastomosis and end-to-side anastomosis.Those with PDA were first ligated and then operated with hypothermia.The arcus aorta was fully dissociated to benefit the resection and anastomosis of narrowness in DHCA.The patients with intracardiac malformation were operated in rewarming phase and end-to-end anastomosis and end-to-side anastomosis were finished in DHCA.In the case that DHCA was over 30 mins,100 ml/(kg · min) was perfused in interval of 5-10 mins.PH-Stat.was used in hypothermia anda-Stat.was used in rewarming phase.Results Twenty-five cases were discharged and 2 cases died,among whom one died from pulmonary hypertension crisis the second day after operation,one died from heart failure induced by bleeding 10 hours after operation.Abnormalism hypertension occurred in 3 cases,yet no sustained hypertension was found.In the 25 cases,chylothorax,alimentary tract hemorrhage,renal failure,lower limb paraplegia were not found.Such complications as arterial aneurysm,intelligence anomaly etc,were not found during the 7 years after operation.Conclusions DHCA,necessary moderate perfusion and MUF with average blood-gas management can not only provide clear vision with less bleeding,but also can provide superior organ protection and satisfactory clinical outcome. Key words: Infant;  Coarctation of aorta(COA) ;  Deep hypothermic circulatory arrest(DHCA) ; Modified ultrafiltration (MUF)