A novel use of Amplatzer duct occluder

Use of the Amplatzer vascular occluder to occlude large venous vessels in adults and children with congenital heart disease: A case series

We describe the use of a new vascular occlusion device to embolize vessels whose flow is detrimental to cardiac function in a variety of clinical situations in both adults and children with congenital cardiac disease. Our series includes four cases in which we have successfully occluded large venous vessels, to produce a beneficial effect on oxygen saturations and cardiac function. There were no adverse events because of the devices in our series, which provides evidence that the Amplatzer vascular plug is a safe and effective method of embolizing large venous vessels.

Percutaneous interventional closure of large pulmonary arteriovenous fistulas with the amplatzer duct occluder

Large pulmonary arteriovenous fistulas (PAVFs) are difficult for transcatheter treatment. This report presents 5 patients aged 3 to 73 years with large PAVFs who underwent successful transcatheter closure with the Amplatzer duct occluder (ADO), designed for the occlusion of patent duct arteriosus. The procedures were performed without complications and provided sustained improvement in arterial oxygen saturation and exercise tolerance on follow-up examination in all patients. The transcatheter closure of large PAVFs with the ADO is effective and can eliminate the need for surgical intervention. The newly designed Amplatzer vascular plug is undergoing clinical trials.

Techniques and applications of transcatheter embolization procedures in pediatric cardiology

Transcatheter embolization of congenital or acquired superfluous vascular structure has become routine procedures performed by interventional pediatric cardiologists. Embolization procedure is often part of a collaborative effort with cardiac surgeons to palliate complex congenital heart defect, such as in embolizing aortopulmonary collateral arteries in patient with single ventricle physiology. In other cases, the procedure is the definitive treatment as in embolizing coronary artery fistula. Pediatric cardiologists performing embolization procedures should be familiar with available technologies as well as understand the underlying cardiac anatomy and pathophysiology. This article provides a comprehensive review of presently available embolization agents and technologies. Some of the technologies are used only by interventional radiologists but may be useful to pediatric cardiologists. Specific clinical applications in pediatric cardiology are also discussed with summary of current literature. With continue advancement in transcatheter technology and operator expertise, all unwanted vascular communication should be amenable to transcatheter embolization.

Closure of the fenestration in the extracardiac Fontan with the Amplatzer duct occluder device

We report the successful use of the Amplatzer duct occluder for the delayed closure of the fenestration in three patients who underwent an extracardiac modified Fontan procedure. At the moment of closure, the patients were 5.5, 2.7, and 3 years old (29 months, 3 months, and 14 months after the Fontan procedure, respectively). Immediate full occlusion was achieved in all cases. In addition, arterial saturation increased significantly (> 5%) with no hemodynamic deterioration. There were no complications during or after the procedure, and the patients were discharged in good conditions the day after and with uneventful follow-up. In conclusion, the Amplatzer duct is safe and effective for the closure of the fenestration in the extracardiac Fontan. Cathet Cardiovasc Intervent 2001;54:88-92.

The use of Amplatzer devices to occlude vascular fistulae

The Amplatzer occluders are Nitinol-based devices that are preshaped for specific indications, primarily to close atrial septal defects, patent foramen ovale/fenestrations, or to occlude patent arterial ducts or one designed specifically for closure of ventricular septal defects. The flexible quality of the Nitinol together with the different designs of Amplatzer occluders make it possible for these plug devices to be used for conditions other than what they are designed for. This is particularly the case for fistulae where no specific devices are available and hence improvisation may be required. The established use of the Amplatzer occluder devices primarily for atrial septal defects and for patent arterial ducts provide the confidence to use them for alternative conditions where few or no alternatives are available or if surgery is the only option. This article describes the use of Amplatzer occluder devices for two unusual conditions, namely to occlude a pulmonary arteriovenous malformation and to close an aorto-left ventricular tunnel.