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

Published online by Cambridge University Press:  13 February 2014

Sean Wallace ,
Gaute Døhlen ,
Henrik Holmstrøm ,
Christian Lund  and
David Russell
Sean Wallace*
Affiliation:
Department of Pediatric Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Gaute Døhlen
Affiliation:
Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Henrik Holmstrøm
Affiliation:
Department of Pediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
Christian Lund
Affiliation:
Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
David Russell
Affiliation:
Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
*
Correspondence to: S. Wallace, Department of Pediatric Neurology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway. Tel: 00 47 46 78 37 49; Fax: 00 47 23 01 57 60; E-mail: seanwallace@live.no
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Abstract

Introduction: The aim of this prospective study was to determine the frequency and composition of cerebral microemboli in a paediatric population during transcatheter atrial septal defect closure. Methods: Multi-frequency transcranial Doppler was used to detect microembolic signals in the middle cerebral artery of 24 patients. Embolic signals were automatically identified and differentiated according to their composition, gaseous or solid. The procedure was divided into five periods: right cardiac catheterisation; left cardiac catheterisation; pulmonary angiography; balloon sizing; and device placement. Results: Microemboli were detected in all patients. The median number of signals was 63 and over 95% gaseous. The total number of microembolic signals detected during two periods – balloon sizing and sheath placement and device placement – was not significantly different (median: 18 and 25, respectively) but was significantly higher than each of the other three periods (p<0.001). In eight patients, the device was opened more than once and the number of embolic signals decreased with each successive device deployment. There was no correlation between the number of microembolic signals and fluoroscopic time, duration of procedure, age, or device size. Conclusion: 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.

Keywords

Atrial septal defecttranscranial Dopplersystemic emboli
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 2 , February 2015 , pp. 237 - 244
Copyright
Copyright &#x00A9; Cambridge University Press 2014 

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References

1. Itoh, S, Suda, K, Kishimoto, S, et al. Microembolic signals measured by transcranial Doppler during transcatheter closure of atrial septal defect using the Amplatzer septal occluder. Cardiol Young 2011; 21: 182–186.Google Scholar
2. Ferrari, J, Baumgartner, H, Tentschert, S, et al. Cerebral microembolism during transcatheter closure of patent foramen ovale. J Neurol 2004; 251: 825–829.Google Scholar
3. Morandi, E, Anzola, GP, Casilli, F, Onorato, E. Silent brain embolism during transcatheter closure of patent foramen ovale: a transcranial Doppler study. Neurol Sci 2006; 27: 328–331.CrossRefGoogle ScholarPubMed
4. Lund, C, Nes, RB, Ugelstad, TP, et al. Cerebral emboli during left heart catheterization may cause acute brain injury. Eur Heart J 2005; 26: 1269–1275.CrossRefGoogle ScholarPubMed
5. Du, ZD, Hijazi, ZM, Kleinman, CS, Silverman, NH, Larntz, K. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 2002; 39: 1836–1844.CrossRefGoogle ScholarPubMed
6. Rigatelli, G, Cardaioli, P, Hijazi, ZM. Contemporary clinical management of atrial septal defects in the adult. Expert Rev Cardiovasc Ther 2007; 5: 1135–1146.Google Scholar
7. Thomas, VC, Vincent, R, Raviele, A, Diehl, H, Qian, H, Kim, D. Transcatheter closure of secundum atrial septal defect in infants less than 12 months of age improves symptoms of chronic lung disease. Congenit Heart Dis 2012; 7: 204–211.Google Scholar
8. Cardenas, L, Panzer, J, Boshoff, D, Malekzadeh-Milani, S, Ovaert, C. Transcatheter closure of secundum atrial defect in small children. Catheter Cardiovasc Interv 2007; 69: 447–452.Google Scholar
9. Diab, KA, Cao, QL, Bacha, EA, Hijazi, ZM. Device closure of atrial septal defects with the Amplatzer septal occluder: safety and outcome in infants. J Thorac Cardiovasc Surg 2007; 134: 960–966.CrossRefGoogle ScholarPubMed
10. Visconti, KJ, Bichell, DP, Jonas, RA, Newburger, JW, Bellinger, DC. Developmental outcome after surgical versus interventional closure of secundum atrial septal defect in children. Circulation 1999; 100: II145–II150.CrossRefGoogle ScholarPubMed
11. Stavinoha, PL, Fixler, DE, Mahony, L. Cardiopulmonary bypass to repair an atrial septal defect does not affect cognitive function in children. Circulation 2003; 107: 2722–2725.CrossRefGoogle Scholar
12. Quartermain, MD, Ittenbach, RF, Flynn, TB, et al. Neuropsychological status in children after repair of acyanotic congenital heart disease. Pediatrics 2010; 126: e351–e359.CrossRefGoogle ScholarPubMed
13. Rodriguez, RA, Hosking, MC, Duncan, WJ, Sinclair, B, Teixeira, OH, Cornel, G. Cerebral blood flow velocities monitored by transcranial Doppler during cardiac catheterizations in children. Cathet Cardiovasc Diagn 1998; 43: 282–290.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
14. de Vries, JW, Hoorntje, TM, Sreeram, N. Neurophysiological effects of pediatric balloon dilatation procedures. Pediatr Cardiol 2000; 21: 461–464.CrossRefGoogle ScholarPubMed
15. Bergersen, L, Gauvreau, K, Jenkins, KJ, Lock, JE. Adverse event rates in congenital cardiac catheterization: a new understanding of risks. Congenit Heart Dis 2008; 3: 90–105.CrossRefGoogle ScholarPubMed
16. Bergersen, L, Marshall, A, Gauvreau, K, et al. Adverse event rates in congenital cardiac catheterization – a multi-center experience. Catheter Cardiovasc Interv 2010; 75: 389–400.CrossRefGoogle ScholarPubMed
17. Momenah, TS, McElhinney, DB, Brook, MM, Moore, P, Silverman, NH. Transesophageal echocardiographic predictors for successful transcatheter closure of defects within the oval fossa using the CardioSEAL septal occlusion device. Cardiol Young 2000; 10: 510–518.Google Scholar
18. Rigby, ML. The era of transcatheter closure of atrial septal defects. Heart 1999; 81: 227–228.CrossRefGoogle ScholarPubMed
19. Thanopoulos, BD, Laskari, CV, Tsaousis, GS, Zarayelyan, A, Vekiou, A, Papadopoulos, GS. Closure of atrial septal defects with the Amplatzer occlusion device: preliminary results. J Am Coll Cardiol 1998; 31: 1110–1116.CrossRefGoogle ScholarPubMed
20. Kannan, BR, Francis, E, Sivakumar, K, Anil, SR, Kumar, RK. Transcatheter closure of very large (>or= 25 mm) atrial septal defects using the Amplatzer septal occluder. Catheter Cardiovasc Interv 2003; 59: 522–527.CrossRefGoogle ScholarPubMed
21. Cassidy, SC, Schmidt, KG, Van Hare, GF, Stanger, P, Teitel, DF. Complications of pediatric cardiac catheterization: a 3-year study. J Am Coll Cardiol 1992; 19: 1285–1293.Google Scholar
22. Vitiello, R, McCrindle, BW, Nykanen, D, Freedom, RM, Benson, LN. Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol 1998; 32: 1433–1440.CrossRefGoogle ScholarPubMed
23. Zeevi, B, Berant, M, Fogelman, R, Galit, BM, Blieden, LC. Acute complications in the current era of therapeutic cardiac catheterization for congenital heart disease. Cardiol Young 1999; 9: 266–272.Google Scholar
24. Agnoletti, G, Bonnet, C, Boudjemline, Y, et al. Complications of paediatric interventional catheterisation: an analysis of risk factors. Cardiol Young 2005; 15: 402–408.Google Scholar
25. Rhodes, JF, Asnes, JD, Blaufox, AD, Sommer, RJ. Impact of low body weight on frequency of pediatric cardiac catheterization complications. Am J Cardiol 2000; 86: 1275–1278, A9.Google Scholar
26. Feltes, TF, Bacha, E, Beekman, RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123: 2607–2652.Google Scholar
27. Bjørnstad, PG, Holmstrøm, H, Smevik, B, et al. Transcatheter closure of atrial septal defects in the oval fossa: is the method applicable in small children? Cardiol Young 2002; 12: 352–356.Google Scholar
28. Brucher, R, Russell, D. Automatic online embolus detection and artifact rejection with the first multifrequency transcranial Doppler. Stroke 2002; 33: 1969–1974.CrossRefGoogle ScholarPubMed
29. Russell, D, Brucher, R. Online automatic discrimination between solid and gaseous cerebral microemboli with the first multifrequency transcranial Doppler. Stroke 2002; 33: 1975–1980.Google Scholar
30. Russell, D, Brucher, R. Embolus detection and differentiation using multifrequency transcranial Doppler. Stroke 2006; 37: 340–341.CrossRefGoogle ScholarPubMed
31. Chen, D, Långstrom, S, Petaja, S, et al. Thrombin formation and effect of unfractionated heparin during pediatric cardiac catheterization. Catheter Cardiovasc Interv 2013; 81: 1174–1179.Google Scholar
32. Leclercq, F, Kassnasrallah, S, Cesari, JB, et al. Transcranial Doppler detection of cerebral microemboli during left heart catheterization. Cerebrovasc Dis 2001; 12: 59–65.CrossRefGoogle ScholarPubMed
33. Bladin, CF, Bingham, L, Grigg, L, Yapanis, AG, Gerraty, R, Davis, SM. Transcranial Doppler detection of microemboli during percutaneous transluminal coronary angioplasty. Stroke 1998; 29: 2367–2370.Google Scholar
34. KA, Busing, Schulte-Sasse, C, Fluchter, S, et al. Cerebral infarction: incidence and risk factors after diagnostic and interventional cardiac catheterization – prospective evaluation at diffusion-weighted MR imaging. Radiology 2005; 235: 177–183.Google Scholar
35. Kofidis, T, Fischer, S, Leyh, R, et al. Clinical relevance of intracranial high intensity transient signals in patients following prosthetic aortic valve replacement. Eur J Cardiothorac Surg 2002; 21: 22–26.CrossRefGoogle ScholarPubMed
36. ZG, Nadareishvili, Beletsky, V, SE, Black, et al. Is cerebral microembolism in mechanical prosthetic heart valves clinically relevant? J Neuroimaging 2002; 12: 310–315.Google Scholar
37. Skjelland, M, Michelsen, A, Brosstad, F, Svennevig, JL, Brucher, R, Russell, D. Solid cerebral microemboli and cerebrovascular symptoms in patients with prosthetic heart valves. Stroke 2008; 39: 1159–1164.Google Scholar
38. Poppert, H, Wolf, O, Resch, M, et al. Differences in number, size and location of intracranial microembolic lesions after surgical versus endovascular treatment without protection device of carotid artery stenosis. J Neurol 2004; 251: 1198–1203.Google Scholar
39. ER, Bossema, Brand, N, Moll, FL, Ackerstaff, RG, van Doornen, LJ. Perioperative microembolism is not associated with cognitive outcome three months after carotid endarterectomy. Eur J Vasc Endovasc Surg 2005; 29: 262–268.Google Scholar
40. van Heesewijk, HP, Vos, JA, Louwerse, ES, et al. New brain lesions at MR imaging after carotid angioplasty and stent placement. Radiology 2002; 224: 361–365.CrossRefGoogle ScholarPubMed
41. Skjelland, M, Krohg-Sorensen, K, Tennoe, B, Bakke, SJ, Brucher, R, Russell, D. Cerebral microemboli and brain injury during carotid artery endarterectomy and stenting. Stroke 2009; 40: 230–234.CrossRefGoogle ScholarPubMed
42. Muller, M, Reiche, W, Langenscheidt, P, Hassfeld, J, Hagen, T. Ischemia after carotid endarterectomy: comparison between transcranial Doppler sonography and diffusion-weighted MR imaging. Am J Neuroradiol 2000; 21: 47–54.Google Scholar
43. Muller, M, Behnke, S, Walter, P, Omlor, G, Schimrigk, K. Microembolic signals and intraoperative stroke in carotid endarterectomy. Acta Neurol Scand 1998; 97: 110–117.Google Scholar
44. Stump, DA. Embolic factors associated with cardiac surgery. Semin Cardiothorac Vasc Anesth 2005; 9: 151–152.Google Scholar
45. CM, Muth, Shank, ES. Gas embolism. N Engl J Med 2000; 342: 476–482.Google Scholar
46. Wang, JK, Tsai, SK, Lin, SM, Chiu, SN, Lin, MT, Wu, MH. Transcatheter closure of atrial septal defect without balloon sizing. Catheter Cardiovasc Interv 2008; 71: 214–221.Google Scholar
47. Quek, SC, Wu, WX, Chan, KY, Ho, TF, Yip, WC. Transcatheter closure of atrial septal defects--is balloon sizing still necessary? Ann Acad Med Singapore 2010; 39: 390–393.Google Scholar