INTERVENTIONAL THERAPY FOR OCCLUSION OF HEPATIC HEMANGIOENDOTHELIOMA LEADING TO CARDIAC FAILURE.

Peuster M, Fink C, Windhagen-Mahnert B, Kardorff R*, Hausdorf G

Department of Pediatric Cardiology and Pediatric Intensive Care *Department of Pediatric Nephology and Metabolic Diseases Hannover Medical School, Germany

OBJECTIVE: To report our experience with coil embolization of multiple tumor-nourishing vessels in 2 newbom babies with hepatic hemangioendothelioma and high-output cardiac failure.

METHODS and RESULTS: Both patients were transfered to our institution because of high output cardiac failure due to a hepatic hemangioendothelioma. Despite the initiation of medical therapy with digoxin, frusemide and corticosteroids the condition of the babies deteriorated. Therefore interventional occlusion of the tumor nourishing vessels was performed. In one patient transcatheter therapy was performed using a venous approach with passage of the catheter to the arterial side using the ductus arteriosus. In the second patient a venous approach was attempted but adequate catheter control could not be achieved, therefore a retrograde arterial approach using the femoral artery was used. After angiography of the tumor-nourishing vessels the vessels were occluded supraselectively to avoid hepatic ischemia in both patients. Symptoms improved rapidly after the intervention and extubation was possible within 2-3 days after the intervention. Duplex-sonograpy of the liver confirmed a decreased blood flow in the hemangioendothelioma after the intervention with regression of the tumor size. Since no histopathologic examination of the tumor was performed the patients were followed with sonography and serological markers for malignant tumors. There was no evidence for malignant hepatic tumors in both patients.

In the patient with an arterial approach occlusion of the femoral artery was evident 2 days after the intervention and was treated with transcatheter recanalization and balloon angioplasty of the femoral artery. Duplex-sonography confirmed a patent femoral artery 3 and 6 months after the intervention.

CONCLUSION: Transcatheter techniques are effective for relief of arteriovenous shunting in patients with hepatic hemangioendothelioma leading to cardiac failure. A venous approach should be used whenever possible to avoid arterial complications after retrograde catheterization. Thorough follow-up with tumor markers and abdominal sonography of the patients is necessary to exclude malignant hepatic tumors.