Outcomes of transcatheter closure of ductus arteriosus in infants less than 6 months of age: a single-center experience / 소아과

PURPOSE: Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. METHODS: We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6–12 months in the same study period were reviewed. RESULTS: A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was 3.3±1.5 months, and weight was 5.7±1.3 kg. The duct diameter at the narrowest point was 3.0±0.8 mm as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6–12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P < 0.01). CONCLUSION: A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.

A Case of Cytomegalovirus Colitis with Nontuberculous Mycobacterium Infection in Immunocompetent Host

Cytomegalovirus(CMV) infections are common in immune compromised situations such as human immunodeficiency virus infection and organ transplantation. However CMV colitis had been rarely found in immunocompetent individuals. We experienced a case of an 83-year-old female patient, initially immune competent, who developed a massive lower gastrointestinal bleeding caused by CMV colitis. Previously, multiple antibiotics were used for nontuberculous Myco- bacterium and other bacterial infections after total knee arthroplasty. Colonoscopy revealed multiple ulcerations and mucosal congestion with hemorrhage. In spite of ganciclovir therapy, our patient did not recover.

A Case of Splenic Infarction Complicating Lymphoma

Splenic infarcts are comparatively less common lesions. Caused by the occlusion of the major splenic artery or any of its branches, they are almost always due to emboli that arise in the heart. The spleen, along with the kidneys and brain, ranks as one of the most frequent sites of localization of systemic emboli. Infarcts may be small or large, multiple or single, and sometimes involve the entire organ. Usually these infarcts are of the bland anemic type. Septic infarcts are found in vegetative endocarditis of the valves of the left side of the heart. Much less often, infarcts in the spleen are caused by local thromboses, especially in leukemia, myeloproliferative syndrome, sickle cell anemia, polyarteritis nodosa, Hodgkin's disease, and bacteremic diseases. We experienced a rather unusual splenic infarction due to lymphoma in a 80-year-old man.

Splenic Infarction, and Common Hepatic Artery and Pulmonary Emboli after Histoacryl(R)(N-butyl-2-cyanoacrylate) Injection for Control of Variceal Bleeding

Bleeding from esophageal and gastric varices is a life-threatening complication for patients with liver cirrhosis. Endoscopic injection of Histoacryl(R)(N-butyl-2-cyanoacrylate) has been reported to be an effective therapy for variceal bleeding; however, distal embolization of unwanted areas has been described in some cases with a fatal outcome. A change in the rationale of treatment of variceal bleeding in patients with liver cirrhosis was not advocated because of the infrequency of such cases. We report two cases of splenic infarction with celiac trunk and pulmonary emboli as serious complications of Histoacryl(R) injection.