Cerebral Microemboli Detection and Differentiation During Transcatheter Closure of Patent Ductus Arteriosus

Abstract

The aim of this prospective study was to determine the frequency and composition of cerebral microemboli in a pediatric population, during transcatheter closure of patent ductus arteriosus (PDA). Multifrequency transcranial Doppler was used to monitor cerebral blood flow velocity (CBFV) and detect microembolic signals (MES) in the middle cerebral artery in 23 patients (median age 18 months). MES were automatically identified and differentiated according to composition; gaseous or solid. The procedure was divided into five periods: Arterial catheterization; venous catheterization; ductal catheterization; angiography; device placement and release. Timing of catheter manipulations and MES were registered and compared. MES were detected in all patients. The median number of signals was 7, (minimum 1, maximum 28). Over 95 % of all MES were gaseous. 11 % were detected during device placement while 64 % were detected during angiographic studies, significantly higher than during any other period (P < 0.001). There was a moderate correlation between the number of MES and volume of contrast used, (R = 0.622, P < 0.01). There was no correlation with fluoroscopic time or duration of procedure. This is the first study to investigate the timing and composition of cerebral microemboli during PDA occlusion. Microemboli were related to specific catheter manipulations and correlated with the amount of contrast used.

Detection of Cerebral High-Intensity Transient Signals by NeoDoppler during Cardiac Catheterization and Cardiac Surgery in Infants

“…Transcatheter interventions had more HITS with EBR 15 dB compared with cardiac surgery. Transcatheter interventions have the same risk factors as the pre-cannulation period of surgeries with administration of medications in venous lines, but also contrast studies that are associated with air emboli (Wallace et al 2016).…”

“…Children with congenital heart disease (CHD) are at risk of gaseous and solid embolus formation with embolization to the cerebral circulation during transcatheter cardiac interventions and cardiac surgery with cardiopulmonary bypass (CPB) (O'Brien et al 1997;Rodriguez et al 1998;Itoh et al 2011;Wallace et al 2016;Larovere et al 2017). Many children with CHD have venous-to-systemic shunts predisposing to passage of emboli to the brain.…”