Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience.

UNLABELLED: In order to define the safety and efficacy of Cook detachable coils for interventional closure of patent ductus arteriosus, we performed a retrospective analysis of all patients who underwent cardiac catheterization in seven centres for intended interventional occlusion of patent arterial duct. From January 1995 until March 1998, cardiac catheterization for intended interventional occlusion of patent arterial duct was performed in 317 consecutive children. Successful placement of at least one coil was achieved in 282 children (89%). The mean diameter of the ductus in children treated with Cook detachable coils was 1.65 mm, mean fluoroscopy time was 10.7 min. Occlusion rates were 62% 10 min after the procedure, 82% at the time of discharge, 91% at 4 months and 95% at late follow-up (2 years). In children with a ductus diameter of < or = 2.5 mm the rate of successful coil deployment was 94% with a 98% occlusion rate at late follow-up. Complications occurred in 11 procedures (3.5%) including haemolysis (3 patients), embolization of a coil to the pulmonary artery (7 patients, 2.3%) and inability to release a coil (1 patient). CONCLUSION: In our opinion, Cook detachable coils are safe and effective especially in the treatment of persistent ductus arteriosus with a diameter < or = 2.5 mm. Due to the low costs these coils appear to be superior to other devices in this subgroup of patients.

[Ultrasound diagnosis of periventricular leukomalacia]. / Sonographische Diagnose der periventrikulären Leukomalazie.

Periventricular leucomalacia (PVL) is the most common form of hypoxemic brain damage in infants. In PVL, there is usually a preceding history of asphyxia or hypoxia. This results in hypoxic-ischaemic damage to the region of the brain around the lateral ventricles, a particularly vulnerable area as it is in a border zone between arterial supplies. PVL is usually first recognised as an echodense heterogenic flare in the anterior and posterior periventricular areas on brain ultrasound scan. This must clearly be differentiated from the typical halo seen in newborns. The formation of pseudocystic periventricular lesions is typically seen after 2 weeks. Thereafter, PVL is characterized by ventricular asymmetry with irregular walls or by cerebral atrophy. Age-specific neurological ultrasound findings are rarely seen in patients with PVL. As these individual developmental stages of PVL cannot always be found by ultrasound scan, the following criteria for diagnosis are recommended: Increased intense and heterogenic echodense areas followed by a breaking up of these echodense areas in the anterior and posterior periventricular regions on brain ultrasound scan. Multiple and thick-walled, initially non-communicating periventricular pseudocysts. Persistent typical asymmetrical dilatation of ventricles with irregular and blurred ventricular walls.

[Ultrasound and clinical studies of periventricular leukomalacia in high risk newborn infants. II. Perinatal risk factors]. / Sonographische und klinische Untersuchungen zur periventrikulären Leukomalazie bei Risikoneugeborenen. II. Perinatale Risikofaktoren.

The incidence of periventricular leukomalacia (PVL) in risk neonates was evaluated among 300 risk neonates in a prospective ultrasound study at the Pediatric Clinic of the Medical Faculty, University of Rostock. Perinatal risk factors for the development of PVL and gestational age were taken into consideration. Maternal infections during pregnancy were found to be a risk factor for development of PVL. A severe hyaline membrane disease was more frequently diagnosed in highly immature preterm neonates with postnatal PVL. The percentage of highly immature preterm neonates with postnatal PVL and severe hyaline membrane disease was higher in vaginal-born risk neonates. A correlation between 1-minute Apgar scores < or = 3 and postnatal PVL was found in more mature preterm neonates.

[Ultrasound and clinical studies of periventricular leukomalacia in high risk newborn infants. I. Neuro-ultrasound results]. / Sonographische und klinische Untersuchungen zur periventrikulären Leukomalazie bei Risikoneugeborenen. I. Neurosonographische Untersuchungsergebnisse.

The incidence of periventricular leukomalacia (PVL) in risk neonates was evaluated in a prospective ultrasound study at the Pediatric Hospital of the Medical Faculty, University of Rostock. The study was carried out in 300 registered risk neonates. These risk neonates were divided into 3 groups: < or = 31 gestational week (n = 70), 32-36 gestational week (n = 154), > or = 37 gestational week (n = 76). A prenatal PVL was diagnosed in 41 neonates, a postnatal PVL was found in 56 neonates after the 5th day of life. In 77% of all risk neonates with PVL, the diagnosis was made on the first day of life. After the first day of life, PVL was presented mainly in highly immature neonates. A correlation of PVL to gestational age could only be found in neonates with postnatal PVL. Subarachnoid space enlargement was found to be significantly more frequent in risk neonates with prenatal PVL than in risk infants with postnatal PVL. Residual ultrasound findings of PVL were significantly more frequent in male than in female risk neonates.