Rapid Ventricular Pacing Facilitates Transarterial Embolization in Vein of Galen Malformations.
Interv Neuroradiol
; 29(2): 183-188, 2023 Apr.
Article
em En
| MEDLINE
| ID: mdl-35234073
ABSTRACT
Background:
Mural type vein of Galen malformation (mVOGM) is a congenital high flow arteriovenous shunt between choroidal arteries and the prosencephalic vein of Markowski leading to heart failure and hydrovenous disorder in children. Embolizing fistulous connections can be challenging and typically requires adjunctive techniques such as induced hypotension, balloon-assisted flow control, and creation of a coil basket. These maneuvers add time, complexity, and unpredictability. Rapid ventricular pacing (RVP) has been proposed as an alternative strategy with fewer drawbacks, but has not been well studied. The approach involves catheterizing the right ventricle with a pacing catheter connected to a temporary external pacemaker. Prior to embolization, RVP is initiated to lower cardiac output. Following embolization, pacing is discontinued, and the heart returns to sinus rhythm.Methods:
We performed RVP in five mVOGM patients from 4/2020 through 7/2021. Accounting for multiple procedures, RVP was utilized in ten cases and twenty-six pedicles.Results:
Ventricular capture was achieved in all instances and was well tolerated, without arrhythmia. Casting the arterial pedicle with liquid embolic immediately adjacent to, or traversing, the fistulous point was achieved in 9/10 cases. There were no procedural complications. In 1 case, creation of a coil basket in the venous pouch was required to achieve a stable arterial castConclusions:
This report describes the largest case series utilizing RVP in mVOGM. The technique appears safe and well tolerated.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fístula Arteriovenosa
/
Embolização Terapêutica
/
Malformações da Veia de Galeno
Limite:
Child
/
Humans
Idioma:
En
Revista:
Interv Neuroradiol
Assunto da revista:
NEUROLOGIA
/
RADIOLOGIA
Ano de publicação:
2023
Tipo de documento:
Article