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Heart and Vessels

, Volume 34, Issue 1, pp 134–140 | Cite as

Collateral closure in congenital heart defects with Amplatzer vascular plugs: single-center experience and a simplified delivery technique for exceptional cases

  • Rouven Kubicki
  • Brigitte Stiller
  • Johanna Hummel
  • Rene Höhn
  • Thilo Fleck
  • Jochen GrohmannEmail author
Original Article
  • 69 Downloads

Abstract

The study describes our experience with Amplatzer Vascular Plugs (AVP2 and 4) and highlights a more refindes telescopic technique for AVP2 delivery. AVPs are well-established occlusion devices for vascular anomalies in congenital heart disease (CHD). The AVP2 is sometimes preferred to the AVP4 due to its shorter length, flat-profiled retention disks, and the availability of larger diameters, but its profile requires a larger inner lumen for safe delivery. The latter may actually hamper access to target lesions. This is a retrospective analysis of all CHD patients treated with the AVP2 and AVP4 between 12/2012 and 12/2015. Target vessels were characterized, measured, and the device-to-vessel diameter ratio calculated. A modified pigtail technique for AVP2 delivery was frequently used: a floppy wire was simply reinforced by the curved tip of a pigtail catheter (instead of the long sheath’s dilator) to guide the required delivery sheath towards the desired landing zone. 59 patients with a median age and bodyweight of 3.0 years (range 0.1–75) and 13.8 kg (range 2.5–80) underwent the implantation of 106 plug-devices (30 AVP2, 76 AVP4) in 91 target vessels. Indications for their use were ductus arteriosus (19%), aortopulmonary (43%) as well as venovenous collaterals (34%) and other miscellaneous lesions (4%). The pigtail-supported AVP2 delivery in six patients proved very convenient. No complications occurred. AVPs are excellent devices for embolizing shunt vessels in CHD patients. Here, we describe a simplified telescoping technique for AVP2 delivery to enter curvy target lesions gently and efficiently.

Keywords

Percutaneous intervention Congenital heart disease Embolization Amplatzer vascular plug Telescopic catheter technique 

Notes

Acknowledgements

We thank Carole Cürten for language editing, Max Grohmann for photography and Stefan Heinz for graphic design.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest and do not have to disclose any agreements.

Supplementary material

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References

  1. 1.
    Feltes Timothy F, Bacha Emile, Beekman Robert H, Cheatham John P, Feinstein Jeffrey A, Gomes Antoinette S, Hijazi Ziyad M, Ing Frank F, Michael de Moor W, Morrow Robert, Mullins Charles E, Taubert Kathryn A, Zahn Evan M (2011) Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 123(22):2607–2652CrossRefGoogle Scholar
  2. 2.
    Porstmann W, Wierny L, Warnke H (1967) Closure of persistent ductus arteriosus without thoracotomy. Ger Med Mon 12(6):259–261Google Scholar
  3. 3.
    Schwartz M, Glatz AC, Rome JJ, Gillespie MJ (2010) The Amplatzer vascular plug and Amplatzer vascular plug II for vascular occlusion procedures in 50 patients with congenital cardiovascular disease. Catheter Cardiovasc Interv 76(3):411–417CrossRefGoogle Scholar
  4. 4.
    Wiegand G, Sieverding L, Bocksch W, Hofbeck M (2013) Transcatheter closure of abnormal vessels and arteriovenous fistulas with the Amplatzer vascular plug 4 in patients with congenital heart disease. Pediatr Cardiol 34(7):1668–1673CrossRefGoogle Scholar
  5. 5.
    Brown SC, Boshoff DE, Eyskens B, Mertens L, Gewillig M (2009) Use of a microcatheter in a telescopic system to reach difficult targets in complex congenital heart disease. Catheter Cardiovasc Interv 73(5):676–681CrossRefGoogle Scholar
  6. 6.
    Krichenko A, Benson LN, Burrows P, Moes CA, McLaughlin P, Freedom RM (1989) Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol 63(12):877–880CrossRefGoogle Scholar
  7. 7.
    Wang W, Li H, Tam MD, Zhou D, Wang DX, Spain J (2012) The Amplatzer vascular plug: a review of the device and its clinical applications. Cardiovasc Interv Radiol 35(4):725–740CrossRefGoogle Scholar
  8. 8.
    Ramakrishnan S (2015) Vascular plugs—a key companion to interventionists—‘Just Plug it’. Indian Heart J 67(4):399–405CrossRefGoogle Scholar
  9. 9.
    Barwad P, Ramakrishnan S, Kothari SS, Saxena A, Gupta SK, Juneja R, Gulati GS, Jagia P, Sharma S (2013) Amplatzer vascular plugs in congenital cardiovascular malformations. Ann Pediatr Cardiol 6(2):132–140CrossRefGoogle Scholar
  10. 10.
    Fischer G, Apostolopoulou SC, Rammos S, Kiaffas M, Kramer HH (2007) Transcatheter closure of coronary arterial fistulas using the new Amplatzer vascular plug. Cardiol Young 17(3):283–287CrossRefGoogle Scholar
  11. 11.
    Hill SL, Hijazi ZM, Hellenbrand WE, Cheatham JP (2006) Evaluation of the Amplatzer vascular plug for embolization of peripheral vascular malformations associated with congenital heart disease. Catheter Cardiovasc Interv 67(1):113–119CrossRefGoogle Scholar
  12. 12.
    Butera G, Hassan E, MacDonald ST (2012) Telescopic catheter-in-long sheath and parallel to a stiff guide wire technique for complex pulmonary artery anatomy. Catheter Cardiovasc Interv 80(4):673–677CrossRefGoogle Scholar
  13. 13.
    Zhu X, Tam MD, Pierce G, McLennan G, Sands MJ, Lieber MS, Wang W (2011) Utility of the Amplatzer vascular plug in splenic artery embolization: a comparison study with conventional coil technique. Cardiovasc Interv Radiol 34(3):522–531CrossRefGoogle Scholar
  14. 14.
    De Santis A, Cifarelli A, Violini R (2010) Transcatheter closure of coronary artery fistula using the new Amplatzer vascular plug and a telescoping catheter technique. J Cardiovasc Med (Hagerstown) 11(8):605–609CrossRefGoogle Scholar
  15. 15.
    Lange M, Bultel H, Weglage H, Loffeld P, Wichter T (2016) Using a steerable guiding sheath to implant an AMPLATZERAmulet Left Atrial Appendage Occluder for prevention of thromboembolic stroke. Int J Cardiol 221:466–467CrossRefGoogle Scholar
  16. 16.
    Jambon E, Petitpierre F, Brizzi V, Dubuisson V, Le Bras Y, Grenier N, Cornelis F (2017) Proximal occlusion of medium-sized vessels with the penumbra occlusion device: a study of safety and efficacy. Cardiovasc Interv Radiol 40(2):210–215CrossRefGoogle Scholar
  17. 17.
    Yu PS, Yu SC, Ng CT, Kwok MW, Chow SC, Ho JY, Underwood MJ, Wong RH (2016) Coil embolization of diverticulum of Kommerell: a targeted hybrid endovascular technique. Ann Thorac Surg 101(5):e139–e141CrossRefGoogle Scholar
  18. 18.
    Fanning NF, Berentei Z, Brennan PR, Thornton J (2007) HydroCoil as an adjuvant to bare platinum coil treatment of 100 cerebral aneurysms. Neuroradiology 49(2):139–148CrossRefGoogle Scholar
  19. 19.
    Conrad MB, Ishaque BM, Surman AM, Kerlan RK Jr, Hope MD, Dickey MA, Hetts SW, Wilson MW (2015) Intraprocedural safety and technical success of the MVP micro vascular plug for embolization of pulmonary arteriovenous malformations. J Vasc Interv Radiol 26(11):1735–1739CrossRefGoogle Scholar
  20. 20.
    Boudjemline Y (2017) Covidien micro vascular plug in congenital heart diseases and vascular anomalies: a new kid on the block for premature babies and older patients. Catheter Cardiovasc Interv 89(1):114–119CrossRefGoogle Scholar
  21. 21.
    Sathanandam S, Justino H, Waller BR 3rd, Gowda ST, Radtke W, Qureshi AM (2017) The medtronic micro vascular plug for vascular embolization in children with congenital heart diseases. J Interv Cardiol 30(2):177–184CrossRefGoogle Scholar
  22. 22.
    MacDonald ST, Carminati M, Butera G (2011) Initial experience with the Amplatzer vascular plug IV in congenital heart disease: coronary artery fistula and aortopulmonary collateral artery embolization. J Invasive Cardiol 23(3):120–124Google Scholar
  23. 23.
    Adelmann R, Windfuhr A, Bennink G, Emmel M, Sreeram N (2011) Extended applications of the Amplatzer vascular plug IV in infants. Cardiol Young 21(2):178–181CrossRefGoogle Scholar
  24. 24.
    Delaney JW, Fletcher SE (2013) Patent ductus arteriosus closure using the Amplatzer(R) vascular plug II for all anatomic variants. Catheter Cardiovasc Interv 81(5):820–824CrossRefGoogle Scholar
  25. 25.
    Zahn EM, Nevin P, Simmons C, Garg R (2015) A novel technique for transcatheter patent ductus arteriosus closure in extremely preterm infants using commercially available technology. Catheter Cardiovasc Interv 85(2):240–248CrossRefGoogle Scholar
  26. 26.
    Baruteau AE, Hascoet S, Baruteau J, Boudjemline Y, Lambert V, Angel CY, Belli E, Petit J, Pass R (2014) Transcatheter closure of patent ductus arteriosus: past, present and future. Arch Cardiovasc Dis 107(2):122–132CrossRefGoogle Scholar
  27. 27.
    Philip R, Waller BR 3rd, Agrawal V, Wright D, Arevalo A, Zurakowski D, Sathanandam S (2016) Morphologic characterization of the patent ductus arteriosus in the premature infant and the choice of transcatheter occlusion device. Catheter Cardiovasc Interv 87(2):310–317CrossRefGoogle Scholar
  28. 28.
    Garay FJ, Aguirre D, Cardenas L, Springmuller D, Heusser F (2015) Use of the amplatzer vascular plug II device to occlude different types of patent ductus arteriosus in pediatric patients. J Interv Cardiol 28(2):198–204CrossRefGoogle Scholar
  29. 29.
    Baruteau AE, Lambert V, Riou JY, Angel CY, Belli E, Petit J (2015) Closure of tubular patent ductus arteriosus with the Amplatzer vascular plug IV: feasibility and safety. World J Pediatr Congenit Heart Surg 6(1):39–45CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical CenterUniversity Heart Center Freiburg, Bad Krozingen, University of FreiburgFreiburgGermany

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