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Coarctation Stenting in a Preterm Neonate With Unrepaired Transposition Using ECMO Venous Cannula Access
Cyndee Jocson1, Brandon Black2, Farshad Anvari3
1Division of Pediatric Cardiology, Manning Family Children's, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
Background:
Cardiac catheterization is essential for diagnosing and treating critically ill infants with congenital heart disease who require venoarterial extracorporeal membrane oxygenation (VA-ECMO). In neonates, cervical cannulation is often preferred because of small femoral vessels.
Case Summary:
A 3-week-old premature male infant with dextro-transposition of the great arteries and coarctation of the aorta (CoA) developed cardiogenic shock and acute kidney injury after atrial septostomy and prostaglandin discontinuation, requiring VA-ECMO. A benchtop model identified the 8-F venous cannula as optimal access. A 7-F sheath was inserted via right internal jugular ECMO tubing, allowing advancement of a coaxial system into the transposed aorta and deployment of a stent across the coarctation. The patient tolerated the procedure and was decannulated.
Discussion:
Cardiac catheterization during ECMO can be performed safely. Although prior reports used arterial cannulas, venous cannulation provided effective access for CoA stenting in this case.
Take-Home Message:
The VA-ECMO circuit provides a feasible route for transcatheter intervention when conventional access is limited.
