Extracorporeal Membrane Oxygenation Support in Severe Hypertrophic Obstructive Cardiomyopathy Associated With Persistent Pulmonary Hypertension in an Infant of a Diabetic Mother

A male infant was delivered at 37 weeks of gestation via cesarean delivery because of minimal fetal heart tone variability and late fetal decelerations to a 31-year-old mother whose pregnancy was complicated by maternal type 2 diabetes mellitus and chronic hypertension. Fetal echocardiography had been performed at 20 weeks of gestation, which showed a structurally normal heart without ventricular hypertrophy (Figure 1 and Movie IA and IB in the online-only Data Supplement). The mother had been treated previously with insulin, and during pregnancy, had hemoglobin A1c of 7.9% (diabetic patients with adequate glycemic control have values <7% to 8%).1 The birth weight was 4.8 kilograms. The infant developed respiratory failure within the first 15 minutes of life, requiring intubation and mechanical ventilation. The umbilical cord venous blood gas demonstrated a pH of 7.16 and partial pressure of oxygen of 31 mm Hg. A transthoracic echocardiogram (TTE) was performed following the patient’s admission to the neonatal intensive-care unit because of auscultation of a grade-IV/VI harsh systolic ejection murmur heard throughout the precordium. TTE showed severe biventricular hypertrophy, mild right ventricular outflow tract obstruction, severe left ventricular outflow tract obstruction with a …