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

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Abstract

This study aimed at evaluating our experience with Micro Vascular Plug (MVP) for embolization of vascular abnormalities in children with congenital heart diseases (CHDs). MVP is one of the most recent additions to the armamentarium for peripheral embolization. Data on its use in congenital cardiology are scarce. Medical records of children with CHDs who had embolizations with MVPs between April 2015 and September 2020 were reviewed. Immediate and follow-up data were assessed. A total of 153 patients underwent 172 procedures during which 240 embolizations using 259 MVPs were attempted. Median age and weight were 34.9 months (IQR, 4-75 months) and 12.5 kg (IQR, 4.8–19.4 kg), respectively. Targets were abnormal systemic arteries (n = 163), patent arterial ducts (n = 26), venous (n = 45), and coronary-cameral fistulas (n = 6). Median vessel diameter was 3.3 mm (IQR, 2.5-4 mm). Veins were larger than arteries (2.3 mm > 2.1 mm, p < 0.01). MVPs were implanted in narrower diameters compared to manufacturer’s recommendations. Compared to veins, solitary implanted MVPs in arteries were additionally oversized at 12.4%, 5.1%, and 7.9% for MVP-3Q, 5Q, and 7Q, respectively. Additional occlusion material (16.7%) and 2 MVPs (5.8%) were needed at the same site for complete closure. Implantation and procedure success rates were 99.2% and 96.7%, respectively. Five complications were treated percutaneously (n = 4) and surgically (n = 1). Efficacy of vascular embolization using MVPs was demonstrated in the largest cohort of children with CHDs and a variety of clinical settings. Immediate and stable closure is obtained with a single device in most cases. Detailed device selection chart according to vessel type and diameter is proposed to achieve intended outcomes.

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Abbreviations

APC:

Aortopulmonary collateral

CHD:

Congenital heart disease

MVP:

Microvascular plug

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Authors and Affiliations

  1. Service de Cardiologie Congénitale et Pédiatrique, Centre de Référence Des Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Universitaire Necker-Enfants Malades, 149, rue de Sèvres, 75015, Paris, France

    Raymond N. Haddad, Damien Bonnet & Sophie Malekzadeh-Milani

  2. Université de Paris, Paris, France

    Damien Bonnet

Authors
  1. Raymond N. Haddad
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  2. Damien Bonnet
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  3. Sophie Malekzadeh-Milani
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Contributions

RH collected all clinical data, double-checked its integrity, performed all statistical calculations, critically analyzed and interpreted the results. RH designed illustrative material and took the lead in writing and revising the entire manuscript. All authors discussed the results, read, and approved the final manuscript.

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Correspondence to Raymond N. Haddad.

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Haddad, R.N., Bonnet, D. & Malekzadeh-Milani, S. Embolization of vascular abnormalities in children with congenital heart diseases using medtronic micro vascular plugs. Heart Vessels 37, 1271–1282 (2022). https://doi.org/10.1007/s00380-021-02007-6

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  • DOI: https://doi.org/10.1007/s00380-021-02007-6

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