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Transcatheter coil closure of pulmonary arteriovenous malformations in children
Lulu Abushaban1, Babu Uthaman, Jerry Endrys
1Department of Cardiology, The Chest Hospital, Kuwait City, Kuwait. lulu@hsc.kuniv.edu.kw
Insights
Transcatheter coil embolization effectively treats pediatric pulmonary arteriovenous fistulas (PAVF), improving oxygen saturation and lung shadows. Multiple procedures may be needed for complete fistula occlusion, with no complications observed.
Area of Science:
- Cardiology
- Pediatric Pulmonology
- Interventional Radiology
Background:
- Pulmonary arteriovenous fistulas (PAVF) are rare lung vascular malformations.
- PAVF can cause cyanosis, epistaxis, hemoptysis, and neurological deficits.
- Effective treatment options for pediatric PAVF are crucial.
Observation:
- A study assessed transcatheter embolization of PAVF in three pediatric patients (8 months to 3 years old).
- All patients presented with cyanosis and low arterial oxygen saturation (mean 64%).
- Multiple coil embolization procedures were performed to occlude the fistulas.
Findings:
- Complete occlusion of PAVF was achieved in all patients after multiple interventions.
- Mean aortic oxygen saturation significantly increased from 66% to 95%.
- Chest radiographs showed dramatic regression of pulmonary shadows post-treatment.
Implications:
- Percutaneous transcatheter coil embolization is a safe and effective treatment for pediatric PAVF.
- Multiple procedures may be necessary for complete fistula occlusion.
- Long-term follow-up is essential to monitor for potential recanalization and recurrence.
Abstract:
Pulmonary arteriovenous fistula (PAVF) is a rare vascular malformation of the lung that may lead to cyanosis, epistaxis, hemoptysis, and neurological deficits or cerebral abscess. The purpose of this study is to assess the effectiveness of percutaneous transcatheter embolization of PAVF in pediatric patients. Transcatheter embolization of PAVF using spring coils was performed in three patients (two males and one female) who presented between 1989 and 1999. The age at presentation ranged from 8 months to 3 years (mean 19.6 months). All patients had cyanosis and clubbing. Neurological, dermatological, or other cardiac manifestations were absent. The arterial oxygen saturations at presentation ranged from 60 to 72% (mean 64%). During eight procedures, multiple coils (total of 41 coils, average 14 coils per patient) were delivered to occlude the fistulas successfully. There was complete occlusion of the fistulas in all patients after the multiple interventions. The aortic saturations increased from a mean of 66% to a mean of 95%. Chest radiographs demonstrated dramatic regression of the pulmonary shadows in all three patients. There were no complications encountered during the procedures or during follow-up. Transcatheter coil embolization of PAVF is a safe and effective method of treatment in the pediatric age group. Patients may require multiple procedures to completely occlude the fistulas. Long-term follow-up is essential to ensure absence of recurrence due to recanalization.
