Transcatheter occlusion of large pulmonary arteriovenous malformations using multiple devices in a neonate.

Pulmonary arteriovenous malformations (PAVMs) are usually well-tolerated hemodynamically. Rarely, they cause severe neonatal cyanosis, requiring urgent treatment. We report the use of multiple transcatheter vascular occlusion devices to reduce right-to-left shunting in a neonate with multiple, large PAVMs.

Transcatheter retrieval of an embolized methylmethacrylate glue fragment adherent to the right atrium using bidirectional snares.

We report the successful transcatheter retrieval of a 6-cm long, rigid methylmethacrylate glue fragment that embolized from a vertebral body to the right atrium. The glue fragment was adherent to the right atrial wall. Two snares were needed, advanced from opposite directions, to carefully separate the glue fragment from the atrial wall, then align it in a linear fashion directly into the sheath for an uneventful removal.

Transcatheter closure of patent ductus arteriosus and aorto-pulmonary vessels using non-ferromagnetic Inconel MReye embolization coils.

OBJECTIVES: We report the use of non-ferromagnetic embolization coils for transcatheter PDA closure. BACKGROUND: Transcatheter patent ductus arteriosus (PDA) closure has been performed for 40 years. A number of devices have been used with varying degrees of success. Gianturco embolization coils have been used frequently since 1992 with excellent results. These coils are a stainless steel alloy, and create an artifact when subsequent MRI imaging is performed. METHODS: Eight patients underwent right and left heart catheterization and transcatheter PDA closure. Angiography displayed a PDA with left to right shunting. The minimum PDA diameter was measured. An Inconel MReye coil was implanted using standard retrograde technique. A postimplant angiogram was performed. Evaluations were performed the following morning and after 2 months. RESULTS: The median age was 5.5 years, median weight was 24 kg. The PDA minimum diameter was 1.7 mm (range 1.4-2.4 mm), with a median Qp:Qs=1.33:1. In all patients, the PDA was completely immediately closed using one Inconel coil. Two patients also had a small aorto-pulmonary collateral vessel that was occluded using a separate Inconel coil. All patients had follow-up evaluation the following day; the PDA remained completely occluded and there was no obstruction of the pulmonary artery branches or descending aorta. Seven patients had subsequent follow-up and echocardiograms; the PDA remained completely occluded. There were no complications. CONCLUSION: The Inconel MReye coil is safe and effective for coil occlusion of small PDA and aorto-pulmonary vessels. Additional studies are needed to define the maximum vessel diameter for Inconel coil occlusion.