Coarctation Stenting in a Preterm Neonate With Unrepaired Transposition Using ECMO Venous Cannula Access
Abstract
Background: Cardiac catheterization is essential for diagnosing and treating critically ill infants with congenital heart disease who require venoarterial extracorporeal membrane oxygenation (VA-ECMO). In neonates, cervical cannulation is often preferred because of small femoral vessels. Case Summary: A 3-week-old premature male infant with dextro-transposition of the great arteries and coarctation of the aorta (CoA) developed cardiogenic shock and acute kidney injury after atrial septostomy and prostaglandin discontinuation, requiring VA-ECMO. A benchtop model identified the 8-F venous cannula as optimal access. A 7-F sheath was inserted via right internal jugular ECMO tubing, allowing advancement of a coaxial system into the transposed aorta and deployment of a stent across the coarctation. The patient tolerated the procedure and was decannulated. Discussion: Cardiac catheterization during ECMO can be performed safely. Although prior reports used arterial cannulas, venous cannulation provided effective access for CoA stenting in this case. Take-Home Message: The VA-ECMO circuit provides a feasible route for transcatheter intervention when conventional access is limited.