A Novel Technique While on Extracorporeal Membrane Oxygenation to Rule Out Anomalous Left Coronary Artery

Abstract

The authors present an infant who required extracorporeal membrane oxygenation (ECMO) for treatment of cardiac failure. Echocardiography could not conclusively demonstrate the origin of the left coronary artery. To rule out anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) as the etiology of the cardiac failure, angiography was deemed necessary. Given the logistic issues involved in moving a patient to the cardiac catheterization suite while receiving ECMO, a method was developed to allow for aortic root injection while on ECMO. The technique involved momentary cessation of ECMO flow to the patient and clamping of the arterial and venous lines followed by injection into the aortic inflow cannula. A chest x-ray demonstrated adequate filling of the aortic arch and adequate visualization of the left coronary artery. While other therapeutic procedures and diagnostic studies have been performed during ECMO, the authors report for the first time a novel technique to allow for aortic arch/coronary artery angiography and provide definitive delineation of the coronary artery anatomy to rule out ALCAPA.