Garcia-Monaco R, De Victor D, Mann C, Hannedouche A, Terbrugge K, Lasjaunias P
Department of Vascular Neuroradiology, Hôpital Bicêtre, Le Kremlin Bicêtre France.
Childs Nerv Syst. 1991 Feb;7(1):48-52. doi: 10.1007/BF00263834.
Since 1984 we have been involved in the management of 30 children who had cardiac manifestations secondary to cerebrocranial arteriovenous shunts. Aneurysm malformation of the vein of Galen was the most common vascular lesion observed (73% of cases). In 77% of the patients the cardiac symptoms were the main presenting complaint. Medical treatment and/or endovascular therapy were indicated, depending on the age of the patients and the severity of the cardiac manifestations. Following embolization, the cardiac symptoms resolved (73%) or improved (18%) in 1 or 2 sessions. Mortality in the embolized group was 9%, and transient nonneurologic morbidity occurred in one case. Overall mortality, including four patients rejected for embolization, was 20%. These results compare favorably with medical and/or surgical management, alone or combined. The technique, challenges, indications and contraindications of endovascular therapy are discussed. Embolization represents an effective adjunct treatment to control, improve or cure the congestive cardiac manifestations caused by cerebrocranial arteriovenous shunts.
自1984年以来，我们参与了30例继发于颅脑血管动静脉分流的心脏表现患儿的管理。大脑大静脉动脉瘤样畸形是最常见的血管病变（73%的病例）。77%的患者以心脏症状为主要就诊主诉。根据患者年龄和心脏表现的严重程度，给予药物治疗和/或血管内治疗。栓塞治疗后，73%的患者在1或2个疗程内心脏症状缓解，18%的患者症状改善。栓塞组的死亡率为9%，1例出现短暂性非神经并发症。包括4例拒绝栓塞治疗的患者在内，总体死亡率为20%。这些结果与单独或联合的药物和/或手术治疗相比更具优势。讨论了血管内治疗的技术、挑战、适应证和禁忌证。栓塞是控制、改善或治愈颅脑血管动静脉分流引起的充血性心脏表现的有效辅助治疗方法。
