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Harlequin Syndrome during Venoarterial Extracorporeal Membrane Oxygenation

2019; Radiological Society of North America; Volume: 1; Issue: 2 Linguagem: Inglês

10.1148/ryct.2019190031

2638-6135

Chetan Pasrija, Kareem Bedeir, Jean Jeudy, Zachary N. Kon,

Cardiovascular and Diving-Related Complications

HomeRadiology: Cardiothoracic ImagingVol. 1, No. 2 Previous Images in Cardiothoracic ImagingFree AccessPulmonary ImagingHarlequin Syndrome during Venoarterial Extracorporeal Membrane OxygenationChetan Pasrija , Kareem Bedeir, Jean Jeudy, Zachary N. KonChetan Pasrija , Kareem Bedeir, Jean Jeudy, Zachary N. KonAuthor AffiliationsFrom the Division of Cardiac Surgery (C.P.) and Department of Radiology (J.J.), University of Maryland, 110 S Paca St, 7th Floor, Baltimore, MD 21201; Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass (K.B.); and New York University, Department of Cardiothoracic Surgery, New York, NY (Z.N.K.).Address correspondence to C.P. (e-mail: [email protected]).Chetan Pasrija Kareem BedeirJean JeudyZachary N. KonPublished Online:Jun 20 2019https://doi.org/10.1148/ryct.2019190031MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In IntroductionA 32-year-old woman had intraoperative cardiac arrest secondary to a pulmonary embolism. After 30 minutes of cardiopulmonary resuscitation, the patient was given venoarterial extracorporeal membrane oxygenation (ECMO) via the femoral artery and vein. Within 72 hours, her native cardiac function improved with increasing pulse pressure, but she paradoxically developed progressive hypoxia isolated to the right face and upper extremity. Axial and oblique maximum intensity projection images from chest CT angiography demonstrate antegrade flow in the ascending aorta and right-sided great vessels via native cardiac ejection and retrograde flow in the descending aorta via the femoral ECMO cannula with preferential flow to the left subclavian artery (Figure).a: (a) Axial and (b) oblique maximum intensity projection images from chest CT angiography demonstrate antegrade flow in the ascending aorta and right-sided great vessels via native cardiac ejection (blue arrow) and retrograde flow in the descending aorta via the femoral extracorporeal membrane oxygenation cannula with preferential flow to the left subclavian artery (red arrow).Download as PowerPointOpen in Image Viewer b: (a) Axial and (b) oblique maximum intensity projection images from chest CT angiography demonstrate antegrade flow in the ascending aorta and right-sided great vessels via native cardiac ejection (blue arrow) and retrograde flow in the descending aorta via the femoral extracorporeal membrane oxygenation cannula with preferential flow to the left subclavian artery (red arrow).Download as PowerPointOpen in Image Viewer When cardiac recovery occurs before the resolution of lung injury, insufficiently oxygenated pulmonary venous return can be ejected, leading to selective hypoxia of the coronary arteries, upper extremities, and brain. This phenomenon, Harlequin syndrome, was named after the 16th-century character Arlecchino (Harlequin), who wore a two-faced mask in his plays.Disclosures of Conflicts of Interest: C.P. disclosed no relevant relationships. K.B. disclosed no relevant relationships. J.J. disclosed no relevant relationships. Z.N.K. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: consultant for Breethe; receives payment for lectures from Medtronic; has stock in Breethe; travel, accommodations, meeting expenses paid by Breethe, Medtronic, and Lung Bioengineering; and pending patent for graded stiffness wire/bidirectional flow cannula (specialty cannula and wire intended for ECMO cannulation). Other relationships: disclosed no relevant relationships.Keywords: Adults, AngiographyAuthors declared no funding for this work.Article HistoryReceived: Feb 16 2019Revision requested: Mar 12 2019Revision received: Apr 5 2019Accepted: Apr 18 2019Published online: June 20 2019 FiguresReferencesRelatedDetailsCited ByExtracorporeal Membrane Oxygenation During PregnancyLuis D.Pacheco, Amir A.Shamshirsaz2023 | Clinical Obstetrics & Gynecology, Vol. 66, No. 1Spinal Cord Infarction With Prolonged Femoral Venoarterial Extracorporeal Membrane OxygenationChetanPasrija, Zachary N.Kon, Michael A.Mazzeffi, JiafengZhang, Zhongjun J.Wu, DouglasTran, Gregory J.Bittle, MehrdadGhoreishi, Timothy R.Miller, HaniAlkhatib, NicoleTobin, Bradley S.Taylor, Kristopher B.Deatrick, RaymondRector, Daniel L.Herr, Bartley P.Griffith2023 | Journal of Cardiothoracic and Vascular AnesthesiaSubclavian versus femoral arterial cannulations during extracorporeal membrane oxygenation: A propensity-matched comparisonMouhamed DjahoumMoussa, NatachaRousse, OsamaAbou Arab, AntoineLamer, GuillaumeGantois, JeromeSoquet, VincentLiu, AgnèsMugnier, ThibaultDuburcq, VincentPetitgand, ValentinFoulon, JocelynDumontet, DelphineDeblauwe, FrancisJuthier, JacquesDesbordes, ValentinLoobuyck, JulienLabreuche, EmmanuelRobin, AndréVincentelli2022 | The Journal of Heart and Lung Transplantation, Vol. 41, No. 5Early hyperoxia and 28-day mortality in patients on venoarterial ECMO support for refractory cardiogenic shock: a bicenter retrospective propensity score-weighted analysisMouhamed DjahoumMoussa, ChristopheBeyls, AntoineLamer, StefanRoksic, FrancisJuthier, GuillaumeLeroy, VincentPetitgand, NatachaRousse, ChristopheDecoene, CélineDupré, ThierryCaus, PierreHuette, MathieuGuilbart, Pierre-GrégoireGuinot, PatriciaBesserve, YazineMahjoub, HervéDupont, EmmanuelRobin, JonathanMeynier, AndréVincentelli, OsamaAbou-Arab2022 | Critical Care, Vol. 26, No. 1Recommended Articles CT Angiography of Venoarterial Extracorporeal Membrane OxygenationRadioGraphics2021Volume: 42Issue: 1pp. 23-37Subclavian Artery: Anatomic Review and Imaging Evaluation of AbnormalitiesRadioGraphics2022Volume: 42Issue: 7pp. 2149-2165Image Predictors of Treatment Outcome after Thoracic Aortic Dissection RepairRadioGraphics2018Volume: 38Issue: 7pp. 1949-1972Congenital Variants and Anomalies of the Aortic ArchRadioGraphics2016Volume: 37Issue: 1pp. 32-51Noninvasive Morphologic and Hemodynamic Evaluation of Type B Aortic Dissection: State of the Art and Future PerspectivesRadiology: Cardiothoracic Imaging2021Volume: 3Issue: 3See More RSNA Education Exhibits CT Angiography of Extracorporeal Membrane Oxygenation: Pearls and PitfallsDigital Posters2020Congenital Thoracic Aortic AnomaliesDigital Posters2018Extracorporeal Membrane Oxygenation (ECMO): What Could Possibly Go Wrong?Digital Posters2020 RSNA Case Collection Leriche syndromeRSNA Case Collection2021Takayasu ArteritisRSNA Case Collection2020Subclavian Stenosis with Pre-StealRSNA Case Collection2021 Vol. 1, No. 2 Metrics Altmetric Score PDF download