Transcatheter closure of coronary artery fistulae using the Amplatzer Duct Occluder.
OBJECTIVE
The aim of this study is to report our experience using the Amplatzer Duct Occluder (ADO) for occlusion of significant coronary artery fistulae (CAF).


BACKGROUND
Transcatheter closure of CAF with coils is well described. Use of newer devices may offer advantages such as improved control of device placement, use of a single instead of multiple devices, and high rates of occlusion.


METHODS
A retrospective review of all patients catheterized for CAF from July 2002 through August 2005 was performed.


RESULTS
Thirteen patients with CAF underwent cardiac catheterization, of which a total of 6 patients had ADO placement in CAF (age, 21 days to 56 years; median age, 4.3 years and weight, 3.8 kg to 74.6 kg; median weight, 13.3 kg). An arteriovenous wire loop was used to advance a long sheath antegrade to deploy the ADO in the CAF. Immediate and short-term outcomes (follow-up, 3 months to 14 months; median follow-up, 8.5 months) demonstrated complete CAF occlusion in 5 patients and minimal residual shunt in 1 patient (who had resolution of right atrial and right ventricular enlargement). On follow-up clinical evaluation, all 6 patients had absence of fistula-related murmurs, and 2 previously symptomatic patients had resolution of congestive heart failure symptoms. Early complications included transient palpitations and atrial arrhythmia in the 2 oldest patients (52 and 56 years old).


CONCLUSIONS
Use of the ADO is applicable for transcatheter closure of significant CAF. Advantages of using the ADO include the antegrade approach, use of a single device, and effective CAF occlusion.
Behera
Sarina K
SK
Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Danon
Saar
S
Levi
Daniel S
DS
Moore
John W
JW
D006328:Cardiac Catheterization; D002648:Child; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000601:surgery*; D004621:Embolization, Therapeutic; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D019736:Prostheses and Implants; D011474:Prosthesis Design; D016157:Vascular Fistula / Q000601:surgery*