Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia: follow-up MRI evaluating carotid artery reocclusion and neurologic outcome.
OBJECTIVE
The purpose of our study was to prospectively assess, using MRI and MR angiography, the cerebral and vascular status of 2-year-old children with congenital diaphragmatic hernia (CDH) in whom carotid artery reconstruction was performed after neonatal extra-corporeal membrane oxygenation (ECMO) therapy and to compare the neurologic development of children with vascular reocclusion with that of CDH children with successful repair and with non-ECMO controls.


METHODS
A total of 30 infants (17 boys, 13 girls; 2 +/- 0.26 years) were included. Of these, 18 (60%) infants received arteriovenous ECMO therapy with subsequent reconstruction of the right common carotid artery (RCCA). Two years postoperatively, the children were examined with cerebral MRI, including 3D time-of-flight and contrast-enhanced 3D MR angiography of the intra- and extracranial brain-supplying arteries. The pathologic findings were analyzed for the ability to predict impaired neurologic development.


RESULTS
The RCCA was occluded or highly stenotic in 13 (72%) of 18 children. All infants showed intra- and extracranial collaterals and a patent internal carotid artery. The average duration of ECMO was not longer than in cases of successful reconstruction (p = 1). The ECMO group showed a significantly greater incidence of cerebral injuries (p = 0.007) but no relevant impairment in neurologic development compared with controls (p = 0.26). Unsuccessful RCCA repair had no predictive value for a poor neurologic outcome (p = 1).


CONCLUSIONS
The outcome of RCCA repair after ECMO is possibly poorer than expected, with vascular occlusion or high-grade stenosis occurring in almost three quarters of patients. Although reocclusion of the RCCA does not increase the risk for cerebral lesions or an impaired neurologic development during the first 2 years postoperatively, the overall benefit of RCCA repair remains doubtful, and the potential long-term risk arising from these plaques has yet to be assessed.
Buesing
Karen A
KA
Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, Mannheim 68167, Germany. karen.buesing@rad.ma.uni-heidelberg.de
Kilian
A Kristina
AK
Schaible
Thomas
T
Loff
Steffan
S
Sumargo
Sabrina
S
Neff
K Wolfgang
KW
D016893:Carotid Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D055502:Secondary Prevention; D016896:Treatment Outcome