Successful transcutaneous arterial embolization of a giant hemangioma associated with high-output cardiac failure and Kasabach-Merritt syndrome in a neonate: A case report

We describe the case of a patient with a neonatal giant cutaneous hemangiom a with high-output cardiac failure and Kasabach-Merritt syndrome and succes sfully treated with transcutaneous arterial embolization aimed at controlli ng severe congestive heart failure and consumption coagulopathy. A patient was admitted to the neonatal care unit on the first day of age because of a large hemangioma on his right lateral chest wall and respiratory distress, associated with cardiac failure resulting from arteriovenous shunting. On the secund day of age the platelet count decreased to 5.7 x 10(4)/mu l and fibrinogen level was 85 mg/dl. The values of prothrombin time and activated partial thromboplastin time were prolonged. Intravenous predonisone therap y was started immediately, but bleeding tendency was getting worse and the evidence of congestive heart failure persisted. On the third day the patien t then underwent embolization of feeding arteries with microcoils. The card iac failure and thrombocytopenic coagulopathy had improved significantly wi thout complications. We conclude that transcutaneous arterial embolization is an effective and safe treatment in this neonate and should be considered for the treatment of control high-output cardiac failure and coagulopathy in infants with hemangioma and Kasabach-Merritt syndrome.