1687 PERMANENT LIGATION OF THE RIGHT COMMON CAROTID ARTERY AT BIRTH: 18 CASES

Abstract

Extra corporeal membrane oxygenation (ECMO) is a heart-lung bypass procedure which involves permanent ligation of the right common carotid artery and internal jugular vein. 18 children who received ECMO as neonates for severe cardiorespiratory insufficiency were studied neurologically 4-11 years after treatment. Cognitive and/or language impairments were noted in 5/18 whereas 72% had a normal neurodevelopmental status. Spastic motor impairment was mild in 3 and severe in 2 patients. Five children had paroxysmal discharges on the EEG but lateralizing findings were not seen in any child. In 10/11 patients studied by noninvasive carotid evaluation, the arterial occlusion could be identified by ultrasound. In these cases the internal carotid artery (ICA) was patent and forward flow in the ICA was achieved by retrograde channeling through the external carotid artery. The size and volume of flow in the right ICA was approximately 50% of that in the left. Asymmetrical auditory cortical evoked potentials were seen in 60% of the 12 cases studied to date with right sided preponderance in the majority. These preliminary findings suggest a possible subclinical effect upon right hemispherel function ipsilateral to the arterial ligation. We conclude that: 1)collateral retrograde flow is established after right common carotid artery ligation at birth and 2)in the majority of patients there are no apparent specific clinical symptoms of right hemispheral dysfunction following the ECMO procedure.

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