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

Abstract

Micro-vascular plug (MVP) is one of the most recent addition to the armamentarium for peripheral embolization. Data on its use in congenital cardiology is scarce. We aim to evaluate our experience with MVP for embolization of vascular abnormalities in children with congenital heart diseases (CHDs). 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 comprehensively 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). Targets were abnormal systemic arteries ( n = 163), patent arterial ducts ( n = 26), venous ( n = 45), and coronary-cameral fistulas ( n = 6). The 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 the 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). The safety and efficacy of vascular embolization using MVPs were demonstrated in the largest cohort of children with CHDs and in a variety of clinical settings. Immediate and stable closure is obtained with a single device in most cases. A detailed device selection chart according to vessel type and diameter is proposed to achieve intended outcomes.