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Extracorporeal Membrane Oxygenation in Infants with Congenital Diaphragmatic Hernia: Follow-Up MRI Evaluating Carotid Artery Reocclusion and Neurologic Outcome

Karen A. Buesing1, A. Kristina Kilian1, Thomas Schaible2, Steffan Loff3, Sabrina Sumargo1 and K. Wolfgang Neff1

1 Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, Mannheim 68167, Germany.
2 Department of Pediatrics, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
3 Department of Pediatric Surgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.


Figure 1
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  		Fig. 1 —Intraoperative view of reconstructed right common carotid artery after 7 days 4 hours of extracorporeal membrane oxygenation therapy in 10-day-old boy. Region of ligatures was excised and end-to-end anastomosis was performed.

 

Figure 2
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  		Fig. 2 —Contrast-enhanced 3D FLASH MR angiography in 2-year-old girl reveals successful repair of right common carotid artery after extracorporeal membrane oxygenation therapy.

 

Figure 3
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  		Fig. 3A —2-year-old girl. Two years postoperatively, coronal (A) and lateral (B) views of 3D FLASH MR angiography show reocclusion of right common carotid artery after extracorporeal membrane oxygenation. Again, cervical collateral blood supply of external carotid artery (arrow) reconstitutes a thin right internal artery that subsequently supplies right intracranial circulation.

 

Figure 4
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  		Fig. 3B —2-year-old girl. Two years postoperatively, coronal (A) and lateral (B) views of 3D FLASH MR angiography show reocclusion of right common carotid artery after extracorporeal membrane oxygenation. Again, cervical collateral blood supply of external carotid artery (arrow) reconstitutes a thin right internal artery that subsequently supplies right intracranial circulation.

 

Figure 5
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  		Fig. 4 —Contrast-enhanced 3D FLASH MR angiography in 2-year-old boy shows highly stenotic right common carotid artery (white arrow) with cervical collaterals (arrowheads) arising from external carotid artery. Diameter of corresponding internal carotid artery is moderately reduced (black arrow).

 

Figure 6
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  		Fig. 5 —Three-dimensional time-of-flight MR angiography in 2-year-old boy shows intracranial collaterals of circle of Willis in child with right common carotid artery reocclusion and moderately reduced diameter of corresponding internal carotid artery.

 

Figure 7
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  		Fig. 6 —Transverse FLAIR image in 2-year-old girl shows asymptomatic residual cortical and subcortical defect of cerebral hemorrhage in left temporooccipital brain parenchyma after cannulation of right common carotid artery for extracorporeal membrane oxygenation therapy.

 

Figure 8
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  		Fig. 7A —2-year-old boy. Transverse T2-weighted images show normal (A) and diffusely enlarged (B) CSF spaces with hyperintense peritrigonal white matter changes, indicating mild brain atrophy and periventricular leukomalacia, possibly due to prolonged hypoxemia in patient 2 years after extracorporeal membrane oxygenation therapy.

 

Figure 9
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  		Fig. 7B —2-year-old boy. Transverse T2-weighted images show normal (A) and diffusely enlarged (B) CSF spaces with hyperintense peritrigonal white matter changes, indicating mild brain atrophy and periventricular leukomalacia, possibly due to prolonged hypoxemia in patient 2 years after extracorporeal membrane oxygenation therapy.

 

Figure 10
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  		Fig. 8 —Comparison of extracorporeal membrane oxygenation (ECMO) patients and non-ECMO controls for pathologic MRI findings and neurodevelopmental outcome. RCCA = right common carotid artery.

 

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