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 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.