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Shunt reduction with a fenestrated Amplatzer device
Oliver Kretschmar1, Anca Sglimbea, Roberto Corti
1Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland. oliver.kretschmar@kispi.uzh.ch
Insights
This study shows that using modified Amplatzer devices for partial shunt closure in high-risk congenital heart disease patients is a successful treatment option. These interventional procedures offer a feasible alternative when complete closure is not possible.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Complete closure of intracardiac defects/shunts is not always feasible in high-risk congenital heart disease (CHD) patients.
- An interventional approach using modified self-fabricated Amplatzer devices was explored for shunt reduction.
- This study reports institutional experiences with this novel technique.
Observation:
- Five patients with CHD underwent interventional partial shunt occlusion using modified Amplatzer devices.
- Treatments included Amplatzer Septal Occluders (ASO) for atrial septal defects (ASD) with restrictive left ventricle (LV) or pulmonary arterial hypertension (PAH), and ASO or Amplatzer Vascular plugs for Fontan circulation with large fenestrations.
Findings:
- Partial shunt occlusion led to immediate volume release and maintained normal pulmonary artery pressure and LV function in ASD patients.
- In Fontan patients, stented devices remained patent, maintaining oxygen saturation >85% and stable pulmonary artery pressures with good clinical condition.
Implications:
- Modified Amplatzer devices offer a feasible and successful therapeutic option for partial shunt closure in specific high-risk CHD patients.
- Balloon-dilated fenestrations may close spontaneously, while sutures or stenting can ensure long-term patency.
Background:
In specific high-risk patients with congenital heart disease (CHD), a complete closure of an intracardiac defect/shunt is not possible for a variety of reasons. We report our experiences with an interventional approach for shunt-reduction using various modifications of a self-fabricated Amplatzer device in our institution.
Methods:
Retrospective analysis of patients with CHD having received an interventional partial shunt occlusion since 09/2005.
Results:
Five patients, mean age 18.6(3.4-66) years, mean weight 36.4(14-102) kg, have been treated. In three patients (3.4, 3.9, 66 years) with an atrial septal defect (ASD) and a restrictive left ventricle (LV) (n = 1) or pulmonary arterial hypertension (PAH) (n = 2), respectively, an Amplatzer Septal Occluder (ASO) with a predilated (n = 2) or a presutured (n = 1) central hole was implanted. After successful immediate volume release in all, the balloon-dilated holes closed spontaneously during mid-term follow-up, pulmonary artery (PA) pressure and LV function remained normal. Two patients (2.7 and 17 years) with a Fontan circulation and severe cyanosis (saturation ≤80%) due to a large fenestration and elevated PA pressures received a partial occlusion of their shunt by implanting a centrally stented ASO or Amplatzer Vascular plug. After a follow-up of 31 and 39 months both stents remained patent under oral anticoagulation, oxygen saturation remained >85% with PA pressures unchanged, and both patients were in good clinical conditions.
Conclusions:
In patients with an ASD and significant PAH and/or restrictive LV physiology as well as in Fontan patients with a large surgically created fenestration but failing Fontan circulation, a partial closure with a self-fenestrated Amplatzer device can be a feasible and successful therapeutic option. Balloon-dilated fenestrations in the Amplatzer device tend to close spontaneously during follow-up. Nonresorbable sutures or stenting can ensure patency of the created holes.
