Cerebral microemboli detection and differentiation during transcatheter closure of atrial septal defect in a paediatric population

Abstract

This is the first study to investigate the timing and composition of cerebral microemboli in a paediatric population during cardiac catheterisation. Microembolic signals were related to specific catheter manipulations but were not associated with fluoroscopic time or duration of procedure.

Cerebral High‐Intensity Transient Signals during Pediatric Cardiac Catheterization: A Pilot Study Using Transcranial Doppler Ultrasonography

“…As we are not aware of published studies using the Sonara™ (Natus Medical Inc., Pleasanton, CA) TCD system for emboli detection in children with CHD undergoing cardiac catheterization, and performance of this system under these circumstances is unknown. We seemed to observe a larger burden of emboli in either clusters or curtains as compared to previous reports . Quantification of HITS close in time (embolic showers) is a major limitation of currently available TCD systems.…”

“…Despite the broad range in underlying cardiac anatomy and physiology and procedures performed, pediatric studies have reported HITS occurring in “bursts” and clusters, often in association with a septal defect and/or right to left shunt . Maneuvers during catheterization for closure of atrial septal defects, namely, sheath placement, balloon sizing, and device placement, have been associated with HITS in children and young adults . Although not recorded for our study, other procedures in the catheterization laboratory, such as blood sampling and injection of drugs, fluids, and contrast agents, have also been reported to produce HITS .…”

“…In a study by Rubiera et al of 51 adults undergoing reperfusion procedures for acute ischemic stroke, HITS and mean flow velocity increases were seen with injections of contrast and intra‐arterial tissue plasminogen activator . Studies using continuous TCD emboli monitoring in children with CHD, however, have typically found either a reduction in CBFV in the setting of pulmonary or aortic balloon dilations, or no significant change in CBFV during catheterization . These CBFV changes in children and adults are more likely related to procedural factors.…”

The relation between atrial septal defect shape, diameter, and area using three-dimensional transoesophageal echocardiography and balloon sizing during percutaneous closure in children

“…Indeed, BS may enlarge the ASD by a laceration of the septum 26 and induces cerebral air microembols. 27 BS also increases the duration of the procedure and irradiation. Some authors moved towards and device selection without BS has already been safely performed.…”

“…BS was performed using the 'pullthrough' technique with the Meditech Equalizer balloon catheter (Boston Scientific, Natick, MA, USA). 13 The chosen occlusion balloon diameter (20,27,33, or 40 mm) was only slightly larger than the 2D-TEE ASD maximal diameter . The occlusion balloon was manually inflated into the left atrium filled with diluted contrast.…”