PURPOSE: The aim of this prospective study was to investigate the incidence of silent cerebrovascular embolic events associated with percutaneous closure of atrial septal defect (ASD) in pediatric patients. METHODS: A total of 23 consecutive pediatric patients (mean age, 10.4±3.8 years; range, 4-17 years) admitted for transcatheter closure of ASD were recruited in the study. The patients were scanned with a 1.5 Tesla clinical scanner. Two cranial magnetic resonance imaging (MRI) examinations were acquired before the procedure and within 24 hours following the catheterization. MRI included turbo spin-echo fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging technique with single-shot echo-planar spin-echo sequence. The transcatheter closure of ASD was performed by three expert interventional cardiologists. Amplatzer septal occluder device was implemented for the closure of the defect. No contrast medium was administered in the course of the procedure. RESULTS: None of the patients had diffusion restricted cerebral lesions resembling microembolic infarctions on postprocedural MRI. Preprocedural MRI of two patients revealed nonspecific hyperintense white matter lesions on FLAIR images with increased diffusion, which were considered to be older ischemic lesions associated with previously occurred paradoxical embolism. CONCLUSION: The current study suggests that percutaneous closure of the ASD, when performed by experienced hands, may be free of cerebral microembolization in pediatric patients. However, due to the relatively small sample size, further studies with larger patient groups are needed for the validation of our preliminary results.
PURPOSE: The aim of this prospective study was to investigate the incidence of silent cerebrovascular embolic events associated with percutaneous closure of atrial septal defect (ASD) in pediatric patients. METHODS: A total of 23 consecutive pediatric patients (mean age, 10.4±3.8 years; range, 4-17 years) admitted for transcatheter closure of ASD were recruited in the study. The patients were scanned with a 1.5 Tesla clinical scanner. Two cranial magnetic resonance imaging (MRI) examinations were acquired before the procedure and within 24 hours following the catheterization. MRI included turbo spin-echo fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging technique with single-shot echo-planar spin-echo sequence. The transcatheter closure of ASD was performed by three expert interventional cardiologists. Amplatzer septal occluder device was implemented for the closure of the defect. No contrast medium was administered in the course of the procedure. RESULTS: None of the patients had diffusion restricted cerebral lesions resembling microembolic infarctions on postprocedural MRI. Preprocedural MRI of two patients revealed nonspecific hyperintense white matter lesions on FLAIR images with increased diffusion, which were considered to be older ischemic lesions associated with previously occurred paradoxical embolism. CONCLUSION: The current study suggests that percutaneous closure of the ASD, when performed by experienced hands, may be free of cerebral microembolization in pediatric patients. However, due to the relatively small sample size, further studies with larger patient groups are needed for the validation of our preliminary results.
Authors: Christian Lund; Ragnhild Bang Nes; Torhild Pynten Ugelstad; Paulina Due-Tønnessen; Rune Andersen; Per Kristian Hol; Rainer Brucher; David Russell Journal: Eur Heart J Date: 2005-02-16 Impact factor: 29.983
Authors: Timothy A Fairbairn; Adam N Mather; Petra Bijsterveld; Gillian Worthy; Stuart Currie; Anthony J P Goddard; Daniel J Blackman; Sven Plein; John P Greenwood Journal: Heart Date: 2011-07-07 Impact factor: 5.994
Authors: R N Bryan; L M Levy; W D Whitlow; J M Killian; T J Preziosi; J A Rosario Journal: AJNR Am J Neuroradiol Date: 1991 Jul-Aug Impact factor: 3.825
Authors: T Ebisu; C Tanaka; M Umeda; M Kitamura; M Fukunaga; I Aoki; H Sato; T Higuchi; S Naruse; Y Horikawa; S Ueda Journal: Radiology Date: 1997-06 Impact factor: 11.105
Authors: Karen A Büsing; Carla Schulte-Sasse; Stephan Flüchter; Tim Süselbeck; Karl K Haase; Wolfgang Neff; Jochen G Hirsch; Martin Borggrefe; Christoph Düber Journal: Radiology Date: 2005-02-24 Impact factor: 11.105
Authors: U Dorenbeck; B Simon; D Skowasch; C Stüsser; A Gockel; H H Schild; H Urbach; G Bauriedel Journal: Eur J Neurol Date: 2007-04 Impact factor: 6.089