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Clinical Experience with Amplatzer ® Vascular Plugs Background: The Amplatzer ® vascular plugs I and II (AVPs I and II) are low profile self-expandable devices made of nitinol, designed for vascular occlusions. We report our experience with these devices in two tertiary referral hospitals. Method: Retrospective study of patients undergoing vascular occlusion procedures with AVPs since 2005. The devices were 30%-50% larger than the target vessel, deployed under general anesthesia via femoral and internal jugular vein or femoral and brachial artery, and delivered through guiding catheters or 5 F to 8 F long sheaths. Results: Fourteen patients (50% male) at a median age of 5 years (11 months to 70 years) and a median weight of 15 kg (8 kg to 67 kg) were identified. Seventeen AVPs were used: 2 AVPs II and 15 AVPs I, with a diameter ranging from 4 mm to 16 mm. In 3 patients with more than one vessel to occlude, 2 AVPs were implanted in each vessel. In 3 patients with coronary fistula total occlusion of the vessels occurred after 24 hours. In 2 patients with modified Blalock-Taussig shunts, there was total occlusion of the anastomosis, with the use of additional coils in one. In 3 patients with venovenous fistulas after Glenn or Fontan operations, there was complete occlusion of the vessels and improved saturation, with the use of additional coils in one. Another patient with venovenous fistula had mild residual shunt in the lab and total occlusion observed at echocardiographic monitoring within 24 hours. Two patients with multiple pulmonary arteriovenous malformations underwent closure using the AVP, other Amplatzer devices and Gianturco's coils, with minimal residual shunts in all cases. In 2 patients with systemic-pulmonary collaterals in the postoperative period of pulmonary atresia and VSD repair, there was complete occlusion with the aid of additional coils, one immediately after the procedure and the other within 24 hours. In one patient with scimitar syndrome the systemic collateral vessel was totally occluded. There was no embolization or death. Conclusion: The AVPs were appro-RESUMO

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Introdução: A experiência com o fechamento percutâneo da comunicação interatrial (CIA) em crianças pequenas é limitada. Avaliamos a factibilidade, a segurança e a eficácia desse procedimento em crianças com peso < 20 kg. Métodos: Estudo descritivo observacional de uma coorte de crianças < 20 kg submetidas a tratamento percutâneo. Pacientes com dilatação ventricular direita e sintomas evidentes foram in cluídos. Implantamos próteses aprovadas pela ANVISA, sob monitorização ecocardiográfica transesofágica. Os pacientes foram avaliados 1 mês, 3 meses, 6 meses e 12 meses após. Resultados: Entre outubro de 1997 e maio de 2012, 80 pacien tes foram tratados. As medianas de idade e peso foram de 4 anos (112) e 13,5 kg (520), respectivamente, 20 pacientes apresentavam alguma síndrome genética (25%) e 4 pacien tes (5%) apresentavam CIA adicional. Somente um paciente necessitou duas próteses. Dois pacientes tinham defeitos ABSTRACT Background: The experience with percutaneous closure of atrial septal defect (ASD) in infants is limited. We sought to determine the feasibility, safety and efficacy of this procedure in children weighing < 20 kg. Methods: Observational study of a cohort of children weighing < 20 kg undergoing percutane ous closure. Patients with right ventricular enlargement and evident symptoms were included. ANVISA approved devices were implanted under transesophageal echocardiography moni toring. Patients were evaluated 1, 3, 6 and 12 months after the procedure. Results: Eighty patients were treated between October 1997 and May 2012. Median age and weight were 4 years (112) and 13.5 kg (520), respectively, 20 patients had a genetic syndrome (25%) and 4 patients (5%) had an additional ASD. Only one patient required 2 devices. Two patients had associated defects that were treated in the same procedure (pulmonary valve stenosis and arteriovenous fistula). One patient developed total atrioventricular block during device implantation, solved spontaneously 36 hours after de vice removal, with no need for pacemaker implantation. This patient was successfully treated percutaneously 6 months later

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5,5 mm e/ou do tipo B foram excluídos do estudo. A prótese foi implantada por vias anterógrada ou retrógrada. A cintura foi cerca de 2 mm maior que o defeito e o comprimento da prótese foi de 4 mm para lesões mais curtas (até 6-8 mm). RESULTADOS: Foram incluídos no estudo 28 pacientes, com mediana de idade e de peso de 2 anos e 11,7 kg, respectivamente, dos quais 23 eram portadores de PCA com diâmetro mínimo de 2,3 + 0,8 mm. Os demais apresentavam comunicação interventricular muscular (1), fístula arteriovenosa pulmonar (1), aneurisma roto do seio de Valsalva (1), e coração univentricular em pós-operatório recente de cavopulmonar bidirecional com fluxo anterógrado pulmonar residual (2). Em todos os pacientes a prótese foi implantada com sucesso, com exceção de um lactente de 8 kg com canal arterial de 2,8 mm de diâmetro, de ampola rasa e de trajeto longo, tortuoso e oblíquo. Houve oclusão total dos defeitos em todos os pacientes. Um paciente portador de coração univentricular e isomerismo direito faleceu em decorrência de complicações não associadas ao procedimento. CONCLUSÕES: A prótese ADO II mostrou-se versátil, segura e eficaz no tratamento percutâneo de lactentes, crianças e adultos selecionados portadores de PCA e outras cardiopatias congênitas e estruturais. Sua aplicação pode ter limitações em algumas configurações anatômicas de PCA em lactentes menores.]]>

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