Renal replacement therapy with a cytokine-adsorbing hemofilter after neonatal open-heart surgery.

Two neonates with right atrial isomerism, single right ventricle, common atrioventricular valve regurgitation, and obstructive extra-cardiac total anomalous pulmonary venous connection underwent emergent total anomalous pulmonary venous connection repair combined with adjustment of pulmonary blood flow soon after birth. After the operation, both patients developed serious capillary leak syndrome, acute kidney injury, and lethal lactic acidosis with hemodynamic instability. Continuous renal replacement therapy was initiated with a cytokine-adsorbing hemofilter of polymethyl methacrylate membrane and a double lumen dialysis catheter inserted directly into the atrium. Elevated serum lactate levels were successfully decreased, and blood pressure was immediately increased.