Shunt reduction with a fenestrated Amplatzer device

Abstract

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.