Tatsuo Oshiro1, Okitaka Nakayama1, Chiaki Ohba1, Yoko Ohashi2, Junichi Kawakubo3, Tomoaki Nagamine4, Masaki Komiyama5. 1. Department of Pediatric Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan. 2. Department of Obstetrics and Gynecology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan. 3. Department of Neurosurgery, Sugioka Memorial Hospital, Fukuoka, Japan. 4. Department of Neurosurgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan. 5. Department of Neuro-Intervention, Osaka City General Hospital, 2-13-22, Miyakojima-Hondori, Miyakojima, Osaka, 534-0021, Japan. komiyama@japan-mail.com.
Abstract
PURPOSE: The purpose of this study was to report transumbilical arterial embolization of a large dural arteriovenous fistula (AVF) in a low-birth-weight neonate with congestive heart failure (CHF). CASE PRESENTATION: A female neonate was delivered by cesarean section at 31 weeks of gestation. Her birth weight was 1538 g and Apgar scores were 6 at both 1 and 5 min. Because of dyspnea and retracted respiration immediately after birth, she required mechanical ventilation. Ultrasound revealed right cardiac overload and a large cystic mass at the posterior brain. Magnetic resonance imaging on day 1 showed a large dural AVF (dural sinus malformation with arteriovenous (AV) shunts) at the torcular herophili. Umbilical artery and vein catheterization were performed on the same day for neurointervention. CHF prompted emergency embolization on day 8. The transfemoral arterial route could not be used because of its small size and compromised femoral artery blood flow. Transumbilical arterial embolization shrank the AV shunts markedly, resulting in clinical improvement, thus requiring no further intervention. Follow-up angiography at 4 months confirmed no residual AVF. Her growth and development were normal at the last follow-up at age 4 years. CONCLUSION: This patient apparently was the lowest birth weight neonate with a large AVF successfully treated by embolization, which is usually performed through the transfemoral arterial route. The transumbilical arterial route is an alternative for neonates with birth weight <2000 g and very small femoral arteries.
PURPOSE: The purpose of this study was to report transumbilical arterial embolization of a large dural arteriovenous fistula (AVF) in a low-birth-weight neonate with congestive heart failure (CHF). CASE PRESENTATION: A female neonate was delivered by cesarean section at 31 weeks of gestation. Her birth weight was 1538 g and Apgar scores were 6 at both 1 and 5 min. Because of dyspnea and retracted respiration immediately after birth, she required mechanical ventilation. Ultrasound revealed right cardiac overload and a large cystic mass at the posterior brain. Magnetic resonance imaging on day 1 showed a large dural AVF (dural sinus malformation with arteriovenous (AV) shunts) at the torcular herophili. Umbilical artery and vein catheterization were performed on the same day for neurointervention. CHF prompted emergency embolization on day 8. The transfemoral arterial route could not be used because of its small size and compromised femoral artery blood flow. Transumbilical arterial embolization shrank the AV shunts markedly, resulting in clinical improvement, thus requiring no further intervention. Follow-up angiography at 4 months confirmed no residual AVF. Her growth and development were normal at the last follow-up at age 4 years. CONCLUSION: This patient apparently was the lowest birth weight neonate with a large AVF successfully treated by embolization, which is usually performed through the transfemoral arterial route. The transumbilical arterial route is an alternative for neonates with birth weight <2000 g and very small femoral arteries.
Authors: P L Lasjaunias; H Alvarez; G Rodesch; R Garcia-Monaco; K Ter Brugge; P Burrows; W Taylor Journal: Interv Neuroradiol Date: 2001-05-15 Impact factor: 1.610