The AMPLATZER Vascular Plug (AVP) (AGA Medical Corp., Golden Valley, MN) is a new occlusion device used for treating arterial venous fistulas and other vascular malformations in the peripheral vasculature. The Plug has recently received FDA approval under a 510k clearance. It is a self-expandable, cylindrical device made from 144 Nitinol mesh wires secured on both ends with platinum marker bands. Unlike other AMPLATZER Occlusion Devices, there is no fabric within the plug. A 135cm long stainless steel delivery cable attaches to the microscrew located on one of the marker bands. The Vascular Plug comes pre-loaded, attached to the delivery cable. AVP range in size from 4-16mm in 2mm increments and are 7-8mm in length. They are delivered through a 5-8Fr standard coronary guide catheter.
Fistulas and arteriovenous malformations have been occluded using various devices including Gianturco┬« coils (Cook, Inc., Bloomington, IN) Grifka Vascular Occlusion Device┬« (Cook, Inc., Bloomington, IN), and AMPLATZER Occlusion Devices (AGA Medical Corp., Golden Valley, MN). Similar to other AMPLATZER devices, the AVP may be repositioned or removed if the placement is not satisfactory. The Vascular Plug selected should be 30% to 50% larger than the diameter of the target vessel (see Figure 1). More than one AVP may be required to achieve complete vessel occlusion. We report our initial experience using the AVP in the treatment of vavascularab vavascular abnormalities associated with congenital heart disease.
A total of 16 AMPLATZER Vascular Plugs were implanted in six patients, ages 15 months to 37 years, with weight 9.5-104.2kg. One patient was referred to The Heart Center at Columbus ChildrenÔÇÖs Hospital for cardiac catheterization and transcatheter device closure of a patent foramen ovale (PFO), which was diagnosed by transesophageal echocardiography (TEE) at an outside institution during a neurologic workup for transient ischemic attacks. Upon reviewing the TEE study prior to catheterization, it was noted that although the bubble contrast study was positive, bubbles appeared to enter the left atrium, posteriorly near the pulmonary veins, after three to four cardiac cycles. A PFO was questionable, but an abnormal right-to-left shunt was certain.