Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram.
*Address for correspondence: Monsy Sam, Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum-695011, Kerala State, India, E-mail: monsysam@yahoo.co.uk.
The ultimate test of skill of a perfusionist lies in conducting cardiopulmonary bypass (CPB) for a neonatal patient. Management of CPB for the neonates weighing below two kilograms is a challenge for the perfusionist. A 19-days old child weighing 1.7 kilograms presented with transposition of great arteries (TGA) for which arterial switch operation was performed. CPB circuit consisted of Baby RX 0.5 membrane oxygenator using 3/16 inch tubes for both arterial and venous lines, with ¼ inch boot line. Blood cardioplegia was delivered through modified Calafiore technique using 150 cms. extension line after the cardioplegia pump. The circuit was primed with 260 ml of haemic prime.
CPB was established by using 8 Fr. aortic and 20 Fr. single right atrium (RA) cannula. The procedure was done at deep hypothermia. CPB time was 275 minutes and aortic cross clamp time of 129 minutes. Total circulatory arrest of 6 minutes used for closing aterial septum defect (ASD). Blood gases were maintained by using Alpha stat strategy. Patient was shifted to intensive care unit (ICU) with open sternum, which was closed on the third day. Post-operative period was uneventful and patient discharged on the 16th postoperated day.
Miniature Circuit, Arterial Switch Operation, Total Circulatory Arrest, Low Prime, Neonates
