Extracardiac Fontan Fenestration Device Closure with Amplatzer Vascular Plug II and Septal Occluder: Procedure Results and Medium-Term Follow-Up

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

“…The 6-month occlusion rate is also excellent (98.5%), suggesting adequate mid-term device thrombosis with subsequent endothelialisation. Moreover, to the best of our knowledge, we report the largest patient series in which AVP II and IV are used to occlude several anatomical shunt varieties including large malformations [8,12,14,16,18,21,[25][26][27][28]. In our experience, AVP II and IV offer excellent paediatric "off-label" alternatives for closure of surgical conduits, aorto-pulmonary collaterals, arterio-venous fistulae, acquired veno-venous communications, sequestration closure, and other miscellaneous lesions [5,8,11,12,15,19].…”

“…A few years later, the highly flexible AVP IV was developed for the adult peripheral vascular structure. The AVP IV (4 to 8 mm; length of 10 to 13.5 mm delivery catheter, 4 to 5 Fr) is adequate for highly tortuous vessels of less than 6 mm in diameter [16,20,21]. Both AVP II and IV are easily re-sheathable and repositionable after partial or complete deployment until best possible position is obtained for optimal release.…”

“…Santa Clara, California, 95054 USA) remain frequently used "off-label" in the paediatric population [6][7][8][9][10][11][12][13]. To the exception of PDA closures [13,14], published data on AVP II and IV use in children and infants remain scarce, particularly in regard to the heterogeneity of procedures and outcomes [15][16][17][18][19][20]. The aim of this study is to describe the efficacy, safety, and characteristics of AVP II and IV "off-label" paediatric utilization for various percutaneous vascular occlusions, including very large tubular PDAs, in children under 10 years.…”

Transcatheter closure of extracardiac Fontan conduit fenestration using new promising materials

“…Fenestration has been shown to improve cardiac output and early postoperative outcomes at the expense of systemic oxygen desaturation and increased risk of thromboembolic events 1,2 . Over the past two decades, several catheterization methods have been described by multiple authors to actively close Fontan fenestration using different vascular occlusion devices and technical difficulties were reported especially in patients with a residual native atrial septum 5,6 . Covered stent implantation inside Fontan conduits allows easy, fast, and effective closure without wire/sheath manipulation across the fenestration or protrusion of prosthetic material in the pulmonary atrium, and with no early mortality or morbidity 4 .…”

“…1,2 Over the past two decades, several catheterization methods have been described by multiple authors to actively close Fontan fenestration using different vascular occlusion devices and technical difficulties were reported especially in patients with a residual native atrial septum. 5,6 Covered stent implantation inside Fontan conduits allows easy, fast, and effective closure without wire/sheath manipulation across the fenestration or protrusion of prosthetic material in the pulmonary atrium, and with no early mortality or morbidity. 4 The covered CP Stent® (NuMED Inc.) is the most commonly used material in our field and was our first choice in this particular intervention, yet special concerns about its nonoptimal performance remain an undeniable fact despite good reported outcomes.…”