{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T14:50:45Z","timestamp":1793803845316,"version":"4.6.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The development of microvascular plugs (MVPs) has enabled novel transcatheter deliverable endoluminal pulmonary flow restrictors (PFRs) with the potential to treat newborns and infants with life-threatening congenital heart diseases (CHDs) in a minimally invasive manner. We present our experience to evaluate the efficacy of this concept in controlling pulmonary blood flow in various CHDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective clinical data review of patients with CHD and pulmonary over-circulation who received bilateral PFRs percutaneously.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-eight PFRs (7 MVP-5Q, 12 MVP-7Q, and 9 MVP-9Q) were finally implanted in 14 patients with a median age of 1.6 months (IQR, 0.9\u20132.3) and a median weight of 3.1\u2005Kg (IQR, 2.7\u20133.6). Nine patients had large intra-cardiac left-to-right shunts (including 3 with fatal trisomy and palliative programs), 2 had borderline left ventricles, 2 had Taussig-Bing anomaly, and one had a hypoplastic left heart. Four patients had concomitant ductal stenting. Two MVP-5Qs were snare-removed and upsized to MVP-7Q. Patients experienced a significant drop in oxygen saturation and Qp\/Qs. All patients were discharged from the ICU after a median of 3.5 days (IQR, 2\u20135.8) postoperative. Five patients had routine inter-stage catheterization and no device embolization or pulmonary branch distortion was seen. Fourteen (50%) PFRs were surgically explanted uneventfully on a median of 4.3 months (IQR, 1.2\u20136) post-implantation during biventricular repair in 6 patients and stage-2 palliation in one patient. The latter died 1 month post-operative from severe sepsis. Four patients are scheduled for surgical PFR removal and biventricular repair. Two patients with trisomy 18 died at 1 and 6.8 months post-procedure from non-cardiac causes. One patient with trisomy 13 is alive at 2.7 months post-procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>It is feasible to bespoke MVPs and implant them as effective PFRs in various CHDs. This approach enables staged left ventricular recruitment, comprehensive stage-2 or biventricular repair with lower risk by postponing surgeries to later infancy. Device explantation is uneventful, and the outcomes afterward are promising.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2023.1150579","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T02:27:30Z","timestamp":1688956050000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":35,"title":["Outcomes of manually modified microvascular plugs to pulmonary flow restrictors in various congenital heart lesions"],"prefix":"10.3389","volume":"10","author":[{"given":"Raymond N.","family":"Haddad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Bentham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Adel Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Al Soufi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Jaber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Issam","family":"El Rassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kasem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1002\/ccd.28162","article-title":"Utility of the medtronic microvascular plug\u2122 as a transcatheter implantable and explantable pulmonary artery flow restrictor in a swine model","volume":"93","author":"Khan","year":"2019","journal-title":"Catheter Cardiovasc Interv"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1161\/CIRCULATIONAHA.120.047668","article-title":"Hypoplastic left heart stage I: no norwood, no hybrid","volume":"142","author":"Schranz","year":"2020","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s00246-021-02597-y","article-title":"Hypoplastic left heart: stage-I will be performed interventionally, soon","volume":"42","author":"Schranz","year":"2021","journal-title":"Pediatr Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1007\/s00246-021-02626-w","article-title":"Total transcatheter stage 1: a word of caution","volume":"42","author":"Nageotte","year":"2021","journal-title":"Pediatr Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s00246-014-1015-2","article-title":"Fifteen-year single center experience with the \u201cGiessen hybrid\u201d approach for hypoplastic left heart and variants: current strategies and outcomes","volume":"36","author":"Schranz","year":"2015","journal-title":"Pediatr Cardiol"},{"key":"B6","first-page":"213","article-title":"The treatment of certain congenital malformations of the heart by the creation of pulmonic stenosis to reduce pulmonary hypertension and excessive pulmonary blood flow; 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