Carotid artery reconstruction following extracorporeal membrane oxygenation
T. M. Crombleholme, N. S. Adzick, A. A. deLorimier, M. T. Longaker, M. R. Harrison and V. E. Charlton
Department of Surgery, University of California, San Francisco.
Right hemispheric brain injury has been noted in surviving infants treated
with venoarterial extracorporeal membrane oxygenation (ECMO). This
phenomenon may be secondary to permanent ligation of the right carotid
artery. At our institution, conventional ventilatory therapy failed in five
neonates with respiratory insufficiency, and they were treated successfully
with ECMO. In four of the five neonates, the right carotid artery was
reconstructed at the time of decannulation. At discharge, all newborns with
carotid artery repair showed no signs of unilateral brain injury and had
excellent antegrade flow in the right carotid artery as assessed by both
duplex and transcranial Doppler ultrasound scanning. Carotid artery
reconstruction after ECMO is a technically simple procedure that may reduce
the incidence of right hemispheric brain injury and long-term consequences
of marginal cerebral perfusion.
