Hybrid peratrial double device closure of a patent foramen ovale and sinus venosus defect in an infant with vein of galen malformation

Abstract

Vein of Galen aneurysmal malformation is the most common cerebral arteriovenous malformation in children. Neurointerventional embolization has improved outcomes with this lesion. An association with cardiac defects has been recognized and can increase the risk of systemic embolic events during treatment. Cardiopulmonary bypass (CPB) to correct the cardiac defect before repair of the malformation may be associated with compromised cerebral perfusion and possible neurologic injury. We describe a successful hybrid peratrial closure of two intracardiac shunts (a patent foramen ovale and a sinus venosus ASD) before neurointervention, avoiding CPB, and eliminating the intracardiac embolic risk during treatment of the vein of Galen malformation.

Repair of Sinus Venosus Defect and Anomalous Pulmonary Veins Associated With Vein of Galen Malformation

“…Successful SVD device closure was reported by Delaney et al in 2011; however, this was performed as a hybrid procedure with surgical fixation of the SVD device to avoid displacement and obstruction of the SVC. 7 Our case demonstrates a percutaneous approach with subsequent device instability requiring surgical intervention and placement of an SVC to RA Gore-Tex graft. Surgical repair using CPB can be a concern as high flow through the VGAM can decrease flow to the cerebral capillary bed.…”

“…Surgical repair using CPB can be a concern as high flow through the VGAM can decrease flow to the cerebral capillary bed. 1,7 However, the risk of CPB with a large cerebral arteriovenous malformation has not been clearly delineated. Ahmad et al reported the case of a patient who underwent SVD repair utilizing CPB prior to VGAM embolization.…”

A cardiopulmonary bypass strategy to support a patient with vein of Galen malformation

“…Placing a patient with VGM onto CPB is considered high risk, if not contraindicated. 3,4 The danger is that systemic arterial blood is shunted across the VGM in such a significant quantity that cerebral and somatic perfusion are reduced to the extent that hypoxic ischaemic injury occurs.…”

“…1 Other authors describe poor outcome without intervention or a hybrid 'peratrial' approach with the intent of avoiding CPB. 2,3 A previous case series recommended 'conservative management' until the VGM had been successfully eradicated. 4 We present a neonate with dissection of the patent ductus arteriosus (PDA) and pulmonary artery with VGM.…”

Malformations cardiaques

“…En raison des risques de la chirurgie, d'une éventuelle circulation extracorporelle et de l'anesthésie chez ces enfants, le traitement de la cardiopathie sera fait autant que possible par cathétérisme interventionnel [506], éventuellement complété par une chirurgie classique dans un second temps [507]. Il semble en effet préférable de les traiter avant ou dans le même temps que la malformation cérébrale, en particulier pour éviter le risque d'embolie paradoxale si un des dispositifs mis en place sur l'anévrisme venait à migrer.…”