AORTIC DISSECTION IN A NEONATE ASSOCIATED WITH ARTERIAL CANNULATION FOR EXTRACORPOREAL LIFE-SUPPORT

The purpose of this paper is to describe the authors' approach to the diagnosis and treatment of aortic intimal dissection encountered as a complication of the arterial cannulation procedure employed routinely during neonatal venoarterial ECMO. A case report is provided. Recognit ion of this entity clinically was based on diminished pulses in the lo wer extremities with dampening of an umbilical arterial catheter trans duced pressure wave form one day after decannulation from ECMO. Confir mation was achieved using a phased array echocardiographic Doppler sys tem (ECHO). Successful surgical repair was achieved under deep hypothe rmic circulatory arrest on cardiopulmonary bypass, with partial resect ion of the affected aorta, and with sutures placed through the intimal flap and the aortic wall. Aortic continuity was established by end-to -end anastamosis posteriorly, and the aortic arch was reconstructed an teriorly with an aortic homograft. To the author's knowledge, this is the first case of this problem being identified and treated in an ECMO treated neonate.