Embolization of vascular abnormalities in children with congenital heart diseases using medtronic micro vascular plugs

Efficacy, Safety and Characteristics of the Amplatzer Vascular Plug II and IV Utilization for Various Percutaneous Occlusions in Children under 10 Years

“…In this multicenter experience, the offlabel utilization of such devices appears effective in children and infants (median age: 1 year). The overall rate of successful AVP implantation (98.5%) constitutes a major indicator of efficacy which compares favourably with previous reports on use of AVPs and other devices formally developed for PDA or vascular occlusions [1][2][4][5][6][7][8][9][10][11][12][13][14]21,[25][26][27][28][29].…”

“…Finally, despite some limited experience with various VSD types, we observe that both AVP devices could be effective in percutaneous VSD closure [25,26]. Furthermore, although recent plugs such as the smallest MVP types [4] can be deployed efficiently using micro catheters to access distal lesions that are not easily treatable in children, we describe that AVP IV can be safely implanted in infants, even of low weight. In addition to an interesting almost immediate thrombotic capacity, this device is also of great flexibility.…”

“…In addition, the rare replacement of a plug by another one of larger size is primarily motivated by potential risk of secondary mobilization, and rarely indicated to obtain immediate complete occlusion. This compares very favourably with the use of more recent devices such as the microvascular plug (MVP, Medtronic™, Minneapolis, MN, USA), for which implantation may require significant oversizing (30% to 60% for venous occlusions, 40% to 70% for arterial occlusions) and the complementary use (20%) of coils or other occluders at the same site to obtain a similar occlusion rate [4]. Overall, this illustrates the very good occlusive capacity of AVP II and IV which is highlighted in the present study, by a low rate (5.2%) of trivial to mild residual intra-prosthetic shunt at Day 1 post-procedure, predominantly described after VSD and CAF closure [25,26].…”

“…In addition to an interesting almost immediate thrombotic capacity, this device is also of great flexibility. AVP IV does not require, contrary to MVPs [4], a straight deployment zone or major oversizing to increase its thrombogenic potential. Additionally, even though AVP IV increases in length upon deployment, it remains usable in the majority of paediatric vascular embolization of vessels ≤6 mm with a sufficient landing zone [10,15,17].…”

“…Continuous development of new techniques and material has made catheter treatment of congenital vascular malformation or congenital heart disease (CHD) possible in children and infants [1][2][3][4][5]. Percutaneous treatment has become the "gold standard" for the majority of patent ductus arteriosus (PDA) closures in children, including premature or low weight infants [1][2]5].…”