Ann Thorac Surg 1997;63:1149-1150
© 1997 The Society of Thoracic Surgeons
Case Report
Transapical Aortic Cannulation in Pediatric Patients
Hiroshi Watanabe, MD,
Shoji Eguchi, MD,
Haruo Miyamura, MD,
Jun-ichi Hayashi, MD,
Hajime Ohzeki, MD,
Masaaki Sugawara, MD,
Masahide Hiratsuka, MD
Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Niigata, Japan
Accepted for publication October 30, 1996.
 |
Abstract
|
|---|
We describe transapical aortic cannulation in pediatric patients. This technique may help to establish cardiopulmonary bypass in small children in whom aortic root cannulation is undesirable or not feasible.
|
Introduction
|
|---|
The ascending aorta is the most common site of arterial cannulation for cardiopulmonary bypass in pediatric patients. If for some reason this site seems to be undesirable in adult patients, the femoral artery is the most common alternative site of arterial cannulation. Alternatively, surgeons can choose the right subclavian artery in patients with extensive iliac and femoral atherosclerotic disease. In pediatric patients, however, the femoral artery and the subclavian artery may be too small for arterial cannulation, and another special technique for arterial cannulation must be used in such situations. We herein present aortic cannulation via the apex of the left ventricle in pediatric patients, which has been applied in adult patients with a severely calcified ascending aorta [1–3]. We used this arterial cannulation technique in a 1-year-old girl with situs solitus, dextrocardia, ventricular septal defect, and pulmonary hypertension. In this patient, the dilated main pulmonary artery covered the whole ascending aorta, and retraction of the main pulmonary artery for exposure of the ascending aorta produced intolerable hypotension.
|
Technique
|
|---|
A wire-reinforced arterial cannula, 10F for neonatal extracorporeal membrane oxygenation (Medtronic Inc, Minneapolis, MN), is inserted through the left ventricular apex via the aortic valve to the ascending aorta (Fig 1
). This arterial cannula is connected to the arterial infusion circuit of cardiopulmonary bypass with a Y-shaped connector. A left atrial cannula is used for venous drainage because of difficulty in accessing the right atrium. After institution of partial cardiopulmonary bypass, right atrial cannulation is performed, and another arterial cannula, connected to the Y-shaped connector, is inserted directly into the ascending aorta by decompressing the heart and retracting the main pulmonary artery (Fig 2). Bicaval cannulation through the right atrium is established, and the arterial cannula is removed via the apex of the left ventricle (Fig 3). Thus, ordinary cardiopulmonary bypass is established and intracardiac repair can be done with cross-clamping of the ascending aorta.
View larger version (36K):
[in this window]
[in a new window]
|
Fig 1. . Transapical aortic cannulation. Partial cardiopulmonary bypass is instituted with transapical aortic cannulation and left atrial cannulation. (LA = left atrium; LV = left ventricle; PA = pulmonary artery; RV = right ventricle.)
|
|
View larger version (37K):
[in this window]
[in a new window]
|
Fig 2. . Right atrial cannulation is performed, and another arterial cannula is inserted directly into the ascending aorta (Ao) by decompressing the heart and retracting the main pulmonary artery (PA). The transapical aortic cannula is pulled back to the left ventricle. (RA = right atrium.)
|
|
View larger version (42K):
[in this window]
[in a new window]
|
Fig 3. . Aortic root cannulation and bicaval cannulation is established. Intracardiac repair can be done with cross-clamping of the ascending aorta.
|
|
|
Comment
|
|---|
Although the ascending aorta is the site of arterial cannulation in almost all pediatric patients, surgeons need another arterial cannulation site in special situations, such as with our patient. In adult patients, the femoral artery or the right subclavian artery is recommended as the alternate site of arterial cannulation. However, the femoral artery and the subclavian artery are too small for cannulation in children with low body weight.
Transapical aortic cannulation has been applied in adult patients with severe diffuse atherosclerotic disease [1–3]. In coronary artery bypass grafting with transapical aortic cannulation, anastomoses of bypass grafts were done with venting of the left ventricle without aortic cross-clamping [2]. In addition, Robicsek [3] has presented the special "double-padded" aortic clamp, which allowed occlusion of the ascending aorta traversed by the perfusion cannula inserted through the apex of the heart. This instrument is useful for cross-clamping the ascending aorta. However, because we did not have this special clamp and the operation must be done with aortic cross-clamping, we started cardiopulmonary bypass with transapical aortic cannulation and subsequently changed to routine aortic root cannulation. Although it is possible to cannulate the external iliac artery using a special artery cannula, transapical aortic cannulation is a useful alternative to the aortic cannulation method in pediatric patients in special situations.
|
Footnotes
|
|---|
Address reprint requests to Dr Watanabe, Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, 757 Asahimachi-dohri 1, Niigata City 951, Japan.
|
References
|
|---|
- Norman JC. A single cannula for aortic perfusion and left ventricular decompression. Chest 1970;58:378–9.[Free Full Text]
- Golding LAR. New cannulation technique for the severely calcified ascending aorta. J Thorac Cardiovasc Surg 1985;90:626–7.[Abstract]
- Robicsek F. Apical aortic cannulation: application of an old method with new paraphernalia. Ann Thorac Surg 1991;51:330–2.[Abstract/Free Full Text]
This article has been cited by other articles:
|
|
|
|
 
S. Wada, S. Yamamoto, J. Honda, A. Hiramoto, H. Wada, and Y. Hosoda
Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations.
J. Thorac. Cardiovasc. Surg.,
August 1, 2006;
132(2):
369 - 372.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Watanabe, I. Fukuda, M. Osaka, and T. Imazuru
Axillary artery and transapical aortic cannulation as an alternative to femoral artery cannulation
Eur J Cardiothorac Surg,
May 1, 2003;
23(5):
842 - 843.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. B. Flege Jr and T. Aberg
Transventricular aortic cannulation for repair of aortic dissection
Ann. Thorac. Surg.,
September 1, 2001;
72(3):
955 - 956.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Abstract
Introduction
