title: Silent cerebral emboli following percutaneous closure of atrial septal defect in pediatric patients: a diffusion-weighted MRI study.
abstract: OBJECTIVE
  The aim of this prospective study was to investigate the incidence of silent cerebrovascular embolic events associated with percutaneous closure of atrial septal defect (ASD) in pediatric patients.
  
  
  METHODS
  A total of 23 consecutive pediatric patients (mean age, 10.4±3.8 years; range, 4-17 years) admitted for transcatheter closure of ASD were recruited in the study. The patients were scanned with a 1.5 Tesla clinical scanner. Two cranial magnetic resonance imaging (MRI) examinations were acquired before the procedure and within 24 hours following the catheterization. MRI included turbo spin-echo fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging technique with single-shot echo-planar spin-echo sequence. The transcatheter closure of ASD was performed by three expert interventional cardiologists. Amplatzer septal occluder device was implemented for the closure of the defect. No contrast medium was administered in the course of the procedure.
  
  
  RESULTS
  None of the patients had diffusion restricted cerebral lesions resembling microembolic infarctions on postprocedural MRI. Preprocedural MRI of two patients revealed nonspecific hyperintense white matter lesions on FLAIR images with increased diffusion, which were considered to be older ischemic lesions associated with previously occurred paradoxical embolism.
  
  
  CONCLUSIONS
  The current study suggests that percutaneous closure of the ASD, when performed by experienced hands, may be free of cerebral microembolization in pediatric patients. However, due to the relatively small sample size, further studies with larger patient groups are needed for the validation of our preliminary results.
authors.affiliation: Department of Pediatric Radiology, Erciyes University School of Medicine, Kayseri, Turkey. ggulkoc@gmail.com.
authors.forename: Gonca
authors.initials: G
authors.lastname: Koç
authors.forename: Abdullah
authors.initials: A
authors.lastname: Özyurt
authors.forename: Selim
authors.initials: S
authors.lastname: Doğanay
authors.forename: Ali
authors.initials: A
authors.lastname: Baykan
authors.forename: S Burcu
authors.initials: SB
authors.lastname: Görkem
authors.forename: M Sait
authors.initials: MS
authors.lastname: Doğan
authors.forename: Özge
authors.initials: Ö
authors.lastname: Pamukçu
authors.forename: Kazım
authors.initials: K
authors.lastname: Üzüm
authors.forename: Abdulhakim
authors.initials: A
authors.lastname: Coşkun
authors.forename: Nazmi
authors.initials: N
authors.lastname: Narin
mesh_terms: D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome