Right coronary artery compression by the right ventricular angulation of the RVS-ECMO cannula
C. Reposition the cannula and repeat the angiogram
The key to the diagnosis is recognizing the potential of cannulae within the right ventricle to compress the RCA (Figure 2; Video 2). While this may not be clinically significant, as in the present case, it may result in malignant arrhythmias or myocardial infarction. Failure to recognize and correct this phenomenon may lead to unnecessary procedures, such as a coronary intervention. Since patient mobilization prior to lung transplant improves posttransplant outcomes, dual-lumen cannulae, such as ProtekDuo, placed from the right internal jugular vein are increasingly used for VV ECMO1- 3 to promote preoperative and postoperative mobilization of patients receiving lung transplants. The most common complications of VV ECMO include vascular injury, bleeding, and hemolysis,2,4 but myocardial infarction secondary to coronary artery compression has been described.5 This report illustrates how the hinge point of the RVS-ECMO cannula in the right ventricle of the RCA may cause extrinsic compression to the RCA. A U-shaped configuration of the cannula, with a less acute angle, is less likely to cause this than a more acute V-shape configuration. If a V shape is recognized after advancing the distal tip of the cannula to the desired position, we advise retracting the cannula under fluoroscopic guidance, which attenuates the angle at the hinge point of the cannula.