An alternative method to fenestrate the extracardiac fontan conduit in a patient with atrial situs inversus and levocardia.

This report describes the technique to fenestrate the extracardiac Fontan conduit without cardiopulmonary bypass in a patient with levocardia and atrial situs inversus.

Low-dose inhaled nitric oxide improves the oxygenation and ventilation of infants and children with acute, hypoxemic respiratory failure.

Objective: To describe the effects of inhaled nitric oxide on oxygenation and ventilation in patients with acute, hypoxic respiratory failure and to characterize those who respond to low doses with a significant improvement in PaO2.

Design: Prospective dose response trial of inhaled nitric oxide. Patients who demonstrated a > or =15% improvement in PaO2 were randomized to receive conventional mechanical ventilation with or without prolonged inhaled nitric oxide.

Extracorporeal membrane oxygenation for nonneonatal pulmonary and multiple-organ failure.

Purpose: Extracorporeal membrane oxygenation (ECMO) is an accepted therapy for neonatal pulmonary failure, but its use in older children has been controversial.

Methods: Over 13 years, 55 children (ages, 3 months to 16 years) were treated with venoarterial or venovenous ECMO. The diagnoses were viral, bacterial, or fungal pneumonia (24 patients); hydrocarbon or gastric aspiration (n = 10); adult respiratory distress syndrome (ARDS), sepsis, near drowning (n = 15); pulmonary contusion (n = 2); airway obstruction (n = 3); pulmonary artery foreign body (n = 1).

Improved survival in congenital diaphragmatic hernia with evolving therapeutic strategies.

Objective: To compare the survival rates for 3 therapeutic eras, each using different treatment strategies for the management of newborns with congenital diaphragmatic hernia (CDH).

Design: Retrospective review of all infants with CDH from 1970 through 1997.

Setting: Tertiary care children's hospital.

The effects of venous occlusion on cerebral blood flow characteristics during ECMO.

Extracorporeal membrane oxygenation (ECMO) in the newborn usually requires occlusion of a jugular vein, and frequently a carotid artery. The acute effects of jugular vein occlusion on cerebral blood flow characteristics have received little investigation. Six newborns (age range, 0 to 5 days; weight, 2.