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. 2017 Jul-Aug;31(4):557-564.
doi: 10.21873/invivo.11094.

Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

Claudia Henzler  1 , Frank G Zöllner  2 , Meike Weis  3 , Fabian Zimmer  2 , Stefan O Schoenberg  3 , Katrin Zahn  4 , Thomas Schaible  5 , K Wolfgang Neff  3
Affiliations

Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

Claudia Henzler et al. In Vivo. 2017 Jul-Aug.

Abstract

Aim: To prospectively evaluate cerebral perfusion after repair of congenital diaphragmatic hernia (CDH) and right-common-carotid-artery (rCCA) occlusion after extracorporeal membrane oxygenation (ECMO) therapy.

Patients and methods: A total of 29 2-year-old-children with a history of CDH repair underwent cerebral magnetic resonance perfusion imaging. In 14 patients, the rCCA was occluded after ECMO therapy. Fifteen patients with CDH without ECMO served as controls. Regional cerebral-blood-flow (rCBF) was measured cortically and subcortically in both hemispheres and compared intra-individually and between both groups.

Results: Patients with rCCA-occlusion showed intra-individual side differences between hemispheres, with significantly lower subcortical perfusion of the right hemisphere and reduced cortical perfusion. In one-third of patients with rCCA-occlusion, rCBF of the right-hemisphere was reduced by more than 20% when compared to the left hemisphere. Despite intra-individual side differences, mean rCBF in patients with rCCA occlusion was not reduced compared to controls.

Conclusion: Beside intra-individual side differences, overall right hemisphere perfusion is sufficient after rCCA-occlusion due to collateral blood supply.

Keywords: Congenital diaphragmatic hernia; cerebral perfusion; common carotid artery occlusion; extracorporeal membrane oxygenation therapy; pulsed arterial spin labeling.

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Figures

Figure 1
Figure 1. Intraoperative view of reconstructed right common carotid artery after extracorporeal membrane oxygenation decannulation in a newborn with congenital diaphragmatic hernia
Figure 2
Figure 2. Time-resolved angiography with stochastic trajectory (TWIST) angiography in a 2-year-old patient without extracorporeal membrane oxygenation therapy and normal cerebral/cervical blood supply (A) and in a 2-year-old patient with occlusion of the right common carotid artery and cervical collateral blood supply via the thyreocervical trunk filling the right internal carotid artery (B). In comparison to the left internal carotid artery, the diameter of the right internal carotid artery is reduced (B)
Figure 3
Figure 3. Pulsed arterial spin labeling image superimposed with T2-weighted morphological image. Cortical (1 and 3) and subcortical (2 and 4) regions of interest
Figure 4
Figure 4. Pulsed arterial spin labeling images of a patient with occlusion of the right common carotid artery after extracorporeal membrane oxygenation therapy and lower perfusion of the right hemisphere (left) compared to a patient of the control group with normal cerebral blood supply (right).
Figure 5
Figure 5. Boxplots of cortical (A) and subcortical (B) regional cerebral blood flow (rCBF) of both hemispheres in the non-extracorporeal membrane oxygenation (ECMO) group (control group) and ECMO group with right common carotid artery (rCCA) occlusion. +: mean value, *denotes significant difference
See this image and copyright information in PMC

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