SURGICAL REPAIR OF AN AORTIC COARCTATION IN A PATIENT AFTER TREATMENTWITH EXTRACORPOREAL MEMBRANE-OXYGENATION

Extracorporeal membrane oxygenation (ECMO) is a lifesaving treatment f or neonates who have severe respiratory failure that does not respond to maximal conventional therapy. A consequence of venoarterial ECMO is the sacrifice of the right common carotid artery. Evaluation of the i mpact of a single carotid artery in babies treated with ECMO concerns mostly long term neurodevelopmental outcome. The authors encountered a peculiar problem caused by a single carotid artery in a post-ECMO pat ient during the surgical correction of aortic coarctation with hypopla stic distal aortic arch. For patients with a confirmed cardiac malform ation that necessitates future surgical repair and for whom ECMO suppo rt is required, reconstruction of the right common carotid artery shou ld be considered. Veno-venous ECMO is an alternative solution if this approach is not contraindicated because of the patient's clinical cond ition. Patients with congenital diaphragmatic hernia have a higher inc idence of cardiac malformations; therefore, careful cardiological atte ntion is required. Anomalies masked by pulmonary hypertension also mus t be considered.