Transvenous Coil Embolization of a Patent Ductus Venosus in a 2-Month-Old Child

Abstract

The ductus venosus, one of three essential shunts existing in the normal fetal circulation, is meant to allow the oxygenated blood from the placenta to bypass the liver and enter the right atrium directly. The ductus venosus in healthy neonates closes after birth later than the ductus arteriosus and usually before the 18th day.1 Patency of the ductus venosus is a rare occurrence and represents either a primary developmental abnormality or a secondary state attributable to established liver cell failure.2 ,3 The diagnosis of this portocaval anastomosis in infants is often made by ultrasound. There are few reports regarding progressive hepatic dysfunction attributable to patent ductus venosus, and the applied treatment was always surgical.4 We describe a rare case of cholestatic jaundice attributable to patent ductus venosus in a 2-month-old boy and a novel, highly successful treatment by transvenous coil embolization. The first child of two young and healthy Druse parents, the boy was the product of a normal pregnancy and delivery. His birth weight was 3.4 kg. At the age of 2 weeks he was hospitalized elsewhere because of poor feeding and jaundice. A cholestatic jaundice with total bilirubin level of 13 mg%, of which 8.5 mg% was direct, was detected. Liver enzymes were markedly elevated with slight impairment of coagulation tests. He was then referred to our hospital for further evaluation and treatment. On admission, physical examination revealed a deeply jaundiced infant with multiple cutaneous hemangioma. Serologic evaluation ruled out intrauterine infection or neonatal viral infection with neonatal hepatitis, and metabolic work-up ruled out …