Transcatheter Intervention for Infantile Hepatic Hemangioendothelioma with Amplatzer Duct Occluder II.
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Date
2014-10
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Abstract
Introduction: Infantile Hepatic hemangioendothelioma is characterized by multifocal
benign vascular dilatations involving the liver. The clinical course depends on tumor size,
localization and complications.
Case Report: 15 days old neonate with stormy postnatal period was referred for
intractable congestive cardiac failure. Transthoracic 2D echocardiography showed
multiple vegetations on all the four valves, noncompaction of left ventricle with multiple
vascular channels in left lobe of liver. Computed tomography angiogram showed
58x29x50 mm markedly enhancing lesion in left lobe of liver suggestive of infantile
hepatic hemangioendothelioma. The neonate was treated for bacterial endocarditis. Later
6x6 Amplatzer duct occluder II was parked in hepatic vein, then gel foam and polyvinyl
chloride particles were injected into infantile hepatic hemangioendothelioma. Cardiac
failure resolved with marked regression of lesion.
Discussion: Infantile hepatic hemangioendothelioma is a rare anomaly causing heart failure in neonate causing death in up to 70% of untreated infants without adequate
regression of lesion. Therefore aggressive treatment is warranted. For the first time in the
world, we report a case of infantile hepatic hemangioendothelioma in a neonate, with
pump failure due to noncompaction of left ventricle and vegetations on all four valves,
successfully treated by combination of transcatheter deployment of Amplatzer duct
occluder II to occlude the venous end and hand injection of gel foam and polyvinly
chloride particles from the aortic end to close the feeder artery.
Conclusion: The combination of closure of hepatic vein by Amplatzer duct occluder II
and injection of gel foam and polyvinyl chloride particles is safe and effective in infantile
hepatic hemangioendothelioma in neonate with heart failure.
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Keywords
Neonatal endocarditis, vegetations, ADO II, gel foam, PVC particles, noncompaction, intractable heart failure LV
Citation
I B Vijayalakshmi, Narasimhan Chitra, Mallikarjun Kavya, Basant Kumar, Madhav Hegde, Manjunath C N. Transcatheter Intervention for Infantile Hepatic Hemangioendothelioma with Amplatzer Duct Occluder II. Cardiology and Angiology An International Journal. 2014 Oct-Dec: 2(4): 317-324.