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

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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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Congenital Heart Disease and Pediatric Cardiology, Faculty of Medicine, Medical Center, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Mathildenstraße 1, 79106, Freiburg, Germany

    Rouven Kubicki, Brigitte Stiller, Johanna Hummel, Rene Höhn, Thilo Fleck & Jochen Grohmann

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  1. Rouven Kubicki
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  2. Brigitte Stiller
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  3. Johanna Hummel
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  4. Rene Höhn
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  6. Jochen Grohmann
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Correspondence to Jochen Grohmann.

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Kubicki, R., Stiller, B., Hummel, J. et al. Collateral closure in congenital heart defects with Amplatzer vascular plugs: single-center experience and a simplified delivery technique for exceptional cases. Heart Vessels 34, 134–140 (2019). https://doi.org/10.1007/s00380-018-1232-3

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  • DOI: https://doi.org/10.1007/s00380-018-1232-3

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