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Stabilizing children with decompensating refractory pulmonary hypertension may require extracorporeal circulatory support. Currently, options in this regard are limited to use of venoarterial extracorporeal membrane oxygenation (ECMO), but this approach is frequently fraught with complications. Alternatively, the interventional pumpless lung-assist membrane ventilator (Novalung GmbH, Heilbronn, Germany) can be used through a femoral artery to femoral vein shunt in patients with end-stage lung disease and hypercapnia or hypoxemia refractory to mechanical ventilation and through a pulmonary artery to left atrium shunt in patients with refractory pulmonary hypertension. The latter configuration has several advantages for children with pulmonary hypertension: (1) It provides a parallel low resistance circuit that drastically decreases right ventricular (RV) afterload and native pulmonary pressure, allowing RV recovery and pulmonary vascular remodeling. (2) It may serve as a long-term pulmonary assist device or as a bridge to lung transplant or a bridge to recovery. (3) It allows physical rehabilitation. Here we report the first successful use of the Novalung surgical lung-assist (sLA) device in a small child with pulmonary hypertension.

First experience with a paracorporeal artificial lung in a small child with pulmonary hypertension