High-Volume Coil Occlusion of Large Vascular Malformations and Aneurysms in Neonates and Infants

Objectives: Congenital vascular malformations associated with arteriovenous communications can lead to severe congestive heart failure due to a significant shunt volume. These malformations include coronary artery fistulae, AV malformations of the lung, and hemangioma of the liver. Surgery in neonates and infants with these malformations is associated with a significant perioperative risk, especially in the presence of an impaired cardiac function. Interventional treatment of these malformations in neonates and infants with different occluding devices is possible. Large volume coils delivered via microcatheters allow superselective catheterization and sustainable closure of vessels. We assessed the safety and feasibility of interventional treatment of large vascular malformations in neonates and infants using high-volume detachable platinum microcoils.

Methods: We retrospectively analyzed all patients younger than 1 year, who were treated with high-volume detachable soft coils at our institution.

Result: Between 2017 and 2020, six neonates and infants (median age: 72.5 days, range: 6–224 days; median weight, 5.95 kg, range: 3.08–7.6 kg) were treated with high-volume detachable soft coils. The malformations included hemangiomas of the liver (n = 3, all with heart failure), AV malformation of the lung (n = 1), aneurysm of the left ventricle (n = 1), and left coronary fistula (n = 1). The coils were delivered in all patients via 2.7-Fr microcatheters using 4-Fr catheters as guiding catheters. The patient with the aneurysm of the left ventricle developed a transient pericardial effusion after intervention which resolved under conservative treatment with furosemide and prednisolone. During a median follow-up of 270.5 days (range: 18–752 days), we saw no other complications. In all three hemangioma patients, no residual flow within the occluded feeding vessels was detected. All lesions show some amount of calcification. All patients with initially impaired cardiac function showed a normal echocardiography result in the last follow-up.

Conclusion: According to our experience, interventional treatment of large vascular anomalies and aneurysms with high-volume detachable soft coils appear to be a feasible and safe method in neonates and infants. In our six patients, we saw no major complications. Follow-up examinations revealed good results after coil occlusion of the complex lesions and resolution of cardiac function in all our patients.

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Artikel online veröffentlicht:
21. Februar 2021