First experience applications of veno-arterial extracorporeal membrane oxygenation in a child with osteosarcoma followed by heart transplantation

Relevance. Life-threatening conditions in pediatric oncology are caused either by tumor diseases or treatment of a tumor disease (chemotherapy-induced cardiotoxicity after the administration of anthracyclines, high doses of cyclophosphamide, ifosfamide, etc.).

Cardiotoxicity occurs over weeks to months and may manifest as restrictive cardiomyopathy with impaired diastolic function or dilated cardiomyopathy with thinning of the left ventricular wall and development of left ventricular systolic dysfunction. Information on the survival of pediatric patients with malignant neoplasms after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) followed by orthotopic heart transplantation is not found in the published literature.

Purpose of the study – to present the experience of a multidisciplinary and multicenter approach in the treatment of a child with osteosarcoma in the event of life-threatening cardiomyopathy with acute circulatory failure, the use of VA-ECMO and subsequent heart transplantation.

Materials and methods. A description of a clinical case of treatment of a 13-year-old child with relapse of osteosarcoma after primary treatment in 9-year-old. The child underwent 5 courses of polychemotherapy with the inclusion of anthracyclines without exceeding cumulative doses. After completion of treatment, the child was diagnosed with chemotherapy-induced dilated cardiomyopathy, manifested by congestive heart failure and the development of cardiogenic shock. The child was initiated for vital indications VA-ECMO followed by orthotopic heart transplantation within 10 days.

Conclusion. During the time the patient was on ECMO, no significant complications were recorded; the child was in remission of the underlying disease, which made it possible to perform a successful donor heart transplantation with standard immunosuppressive therapy. During the observation period of 14 months, the heart transplant functioned satisfactorily.

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