Efficacy,Safety and Characteristics of the Amplatzer Vascular Plug II and IV Utilization for Various Percutaneous Occlusions in Children under 10 Years

Objectives:We aim to describe the efficacy,safety,and characteristics of the Amplatzer Vascular Plug(AVP)II and IV“off-label”use for multiple cardiovascular occlusions in children under 10 years.Methods:Observational retrospective multicenter(2007–2020,6 centers)review of paediatric procedures using AVP II or IV.Results:A total of 125 children(49.6%aged≤1 year,147 lesions)underwent 136 successive procedures(success rate:98.5%)using 169 devices(109 AVP IV,60 AVP II).The mean device diameter was 7.7±3.2 mm(4–20 mm).The median AVP size to vessel diameter ratio was 1.3(0–2).The median age and weight at implantation were 1.0 year(0.01–9.98)and 8.4 kg(1–69).Procedures were heterogeneous(55 patent ductus arteriosus(PDA),28 collaterals,18 sequestrations,22 arteriovenous/veinovenous/coronary fistulas,6 vertical veins,6 conduits,5 ventricular septal defects,7 miscellaneous).Day 1 and 6-month occlusion rates were respectively 94.8%and 98.5%.Major adverse events(MAE)occurred in 5.2%of cases(no procedure-related deaths),and more frequently in weight≤5 kg(p=0.01),younger patients(p=0.03)during PDA closure(p=0.02)of tubular types(p=0.02)using larger devices(p=0.03)and AVP II(p=0.003).Independent predictor of MAE risk was a higher AVP diameter to patient weight ratio(Odds-ratio:2.33,95%confidence interval 1.31–4.13,p=0.004,optimal cut off:1.45).Conclusions:Both AVPs are safe and effective for percutaneous occlusions in children under 10.Such devices represent an alternative“off label”use for well selected paediatric patients.

Assessment of left-ventricular diastolic function in pediatric intensive-care patients:a review of parameters and indications compared with those for adults

Background The incidence of diastolic heart failure has increased over time.The evaluation of left-ventricular diastolic func-tion is complex,ongoing,and remains poorly performed in pediatric intensive-care patients.This study aimed to review the literature and to provide an update on the evaluation of left-ventricular diastolic function in adults and children in intensive care.Data sources We searched data from PubMed/Medline.Thirty-two studies were included.Four pragmatic questions were identified:(1)What is the physiopathology of diastolic dysfunction?(2)Which tools are required to evaluate diastolic func-tion?(3)What are the echocardiographic criteria needed to evaluate diastolic function?(4)When should diastolic function be evaluated in pediatric intensive care?Results Early diastole allows characterization of relaxation,whereas compliance assessments and filling pressures are evalu-ated during late diastole.The evolution of diastolic function differs between adults and children.Unlike in adults,decreased compliance occurs at the same time as delayed relaxation in children.Diastolic function can be evaluated by Doppler echo-cardiography.The echocardiographic criteria for ventricular relaxation include the E wave,E/A wave ratio,and isovolumic relaxation time.Ventricular compliance can be assessed by the E/e'wave ratio,atrial volume,and Ap wave duration during pulmonary vein flow.In adult intensive-care patients,the E/e'ratio can be used as an index of tolerance for volume expan-sion in septic patients and to adjust the inotropic support.Conclusion Clinical studies would allow some of these parameters to be validated for use in children in intensive care.