Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease — ultrasound with multimodality correlation

Abstract

Cranial ultrasound on neonatal intensive care units is generally performed by intensive care physicians, but radiologists often provide this crucial bedside test to children on specialist paediatric cardiac intensive care units. On a paediatric cardiac intensive care unit, complex congenital cardiac conditions are commonly encountered in both pre-and postoperative scenarios, often with the use of extracorporeal membrane oxygenation (ECMO), which both increases the risks of a number of neurologic complications and results in significant changes in vascular physiology. The aim of this pictorial essay is to discuss cranial ultrasound technique, demonstrate the changes in Doppler flow profiles resulting from veno-arterial extracorporeal membrane oxygenation and congenital cardiac conditions, and illustrate commonly encountered intracranial complications of extracorporeal membrane oxygenation support in congenital cardiac care.

Utility of Cerebral Microvascular Imaging in Infants Undergoing ECMO

“…The study shows feasibility of visualization and monitoring of whole brain microvascular flow real-time using MVI during ECMO. Grayscale US is the standard of care and allows detection of major cerebrovascular events such as hemorrhage [ 21 , 22 ]. MVI supplements conventional tools such as grayscale US by providing functional insights into the brain, namely helping to measure cerebral blood flow and its surrogate which are important in assessing tissue viability and risk of injury [ 23 , 24 , 25 ].…”

Postoperative nursing care of a child with pulmonary artery displacement combined with slide tracheobronchial plasty

“…Postoperative pulmonary nursing is related closely to the condition of children with PAS, especially those who undergo airway angioplasty. Therefore, bedside ultrasound is an ideal tool for assessing lung status 29 . It enables the achievement of a clear goal of clinical nursing, and therefore effective nursing measures can be performed as early as possible, reducing relevant complications and accelerating lung recovery 30 .…”

“…Therefore, bedside ultrasound is an ideal tool for assessing lung status. 29 It enables the achievement of a clear goal of clinical nursing, and therefore effective nursing measures can be performed as early as possible, reducing relevant complications and accelerating lung recovery. 30 In our case, bedside lung ultrasound was performed daily to help identify pulmonary consolidation, atelectasis, and pneumonia.…”

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“…50 However, cranial ultrasound is useful to diagnose this complication, in case with after closure of the anterior fontanelle, CT, or magnetic resonance imaging is needed to diagnose this complication. 51 Magnetic resonance imaging does not have need of radiation exposure, but it needs the relative longer time for examination compared the CT. The values of the resistive index, peak systolic, end diastolic, and time-averaged velocities of intracranial artery are determined by using Doppler techniques, and that is useful for the diagnosis, follow-up, and management of brain damage.…”

“…The echogenicity anterior to the caudothalamic groove represents blood as the choroid plexus finishes at the caudothalamic groove, and the choroid plexus hemorrhage is diagnosed sonographically when the affected side is enlarged, or irregular in contour as compared with the contralateral nonaffected side. 51,[54][55][56] Sequelae, such as hydrocephalus and brain atrophy, can also be evaluated using ultrasound. 48,57…”