title: 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.
authors.affiliation: Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland. oliver.kretschmar@kispi.uzh.ch
authors.forename: Oliver
authors.initials: O
authors.lastname: Kretschmar
authors.forename: Anca
authors.initials: A
authors.lastname: Sglimbea
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Walter
authors.initials: W
authors.lastname: Knirsch
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002404:Catheterization; D002675:Child, Preschool; D003326:Coronary Circulation; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology / Q000628:therapy; D006345:Heart Septal Defects, Ventricular / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011474:Prosthesis Design; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D055989:Septal Occluder Device; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D000925:Anticoagulants