Cardiac Computed Tomographic Angiography in Pediatric Patients on Veno-Arterial ExtraCorporeal Membrane Oxygenation Support
2Pediatric Cardiology, Safra Children's Hospital at Sheba Medical Center, Israel
3Pediatric Cardiothoracic Surgery, Safra Children's Hospital at Sheba Medical Center, Israel
4Diagnostic Imaging, Sheba Medical Center, Israel
5Cardiac Intensive Care, Safra Children's Hospital at Sheba Medical Center, Israel
Purpose: Cardiac Computed Tomographic Angiography (CCTA) was used to evaluate pediatric patients failing to wean from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We describe the technical challenges, technique, and the quality and impact of the results.
Methods: This retrospective study describes the use of CCTA for eighteen examinations in seventeen pediatric patients (age: 1 month to 7 years, weight: 3 - 30 kg) on VA-ECMO support. Congenital heart disease (CHD) was present in 16 patients. One suffered from dilated cardiomyopathy. Of the CHD patients, fifteen CCTA examinations were performed post-surgery; two examinations were performed before surgery.
All patients underwent both CCTA and echocardiography. All CT scans were performed with ECG gating with exposure settings slightly raised due to scanning thru extensive hardware. Patients with low cardiac function underwent an intra-aortic cannula injection to evaluate the aorta and coronary arteries (N=11). Intravenous (IV) injection was performed to precisely define the cardiothoracic anatomy or quality of the surgical result (N=7). One patient had both an intra-aortic cannula injection and intravenous injection, in two separate CCTA examinations.
Results: Intra-aortic cannula injection (N=11) demonstrated coronary artery pathology in six of the eleven examinations. Intravenous (IV) contrast injection (N=7) demonstrated pathologies in five of the six examinations. None of the pathologies were visualized on echocardiography (both trans-thoracic and trans-esophageal echo were performed in 15 of the 17 patients). Radiation exposure was minimized as much as possible, and there were no adverse events related to the transport or the CT environment.
Conclusions: Tailored CCTA can be performed in these challenging pediatric patients supported by VA-ECMO. It offers accurate noninvasive anatomic delineation and identifies pathologies not demonstrated by echocardiography and confirmed by surgery. CCTA should be considered for the evaluation of patients when attempts to wean from ECMO support fail. It may significantly change the patient`s outcome.