title: Initial experience with the Amplatzer Vascular Plug IV in congenital heart disease: coronary artery fistula and aortopulmonary collateral artery embolization.
abstract: BACKGROUND
  A number of percutaneous devices are available to embolize anomalous vessels in congenital heart disease. We report our initial single-center experience with the new Amplatzer Vascular Plug IV (AVP IV) in congenital heart disease to embolize a coronary artery fistula and aortopulmonary collateral arteries in 4 cases.
  
  
  METHODS
  From August 2009 until April 2010, 7 AVP IV devices were deployed in 4 patients, age range 5 months to 9 years, weight 3.5-27.7 kg. One patient had a large coronary artery fistula, the others had anomalous aortopulmonary collaterals; 2 patients had tetralogy of Fallot with pulmonary atresia, with the other having dextrocardia, anomalous pulmonary venous drainage and pulmonary atresia.
  
  
  RESULTS
  In all 4 patients, vessels intended to be closed with the AVP IV were closed successfully with minimal residual shunting and no device failures. Deployed devices ranged from 4-8 mm in diameter. One patient had 4 devices, closing large branching infradiaphragmatic aortopulmonary collaterals. The other 3 patients had single devices. Complete vessel embolization was seen with no device embolization or implantation complication.
  
  
  CONCLUSIONS
  This preliminary experience illustrates the utility of the AVP IV in congenital heart disease, occluding a coronary artery fistula and aorto-pulmonary collaterals, with devices between 4 mm and 8 mm in diameter, demonstrating its safety and effectiveness. It is particularly useful in embolizing difficult-to-reach large, tortuous vessels with a small-sized catheter in a single procedure. Longer-term follow up in a larger cohort of patients will be required to establish long-term efficacy and device safety.
authors.affiliation: Department of Paediatric Cardiology and Adult Congenital Heart Disease, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese (MI), Italy.
authors.forename: Simon T
authors.initials: ST
authors.lastname: MacDonald
authors.forename: Mario
authors.initials: M
authors.lastname: Carminati
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Butera
mesh_terms: D001159:Arterio-Arterial Fistula / Q000628:therapy; D057785:Catheters; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D003330:Coronary Vessel Anomalies / Q000628:therapy*; D003914:Dextrocardia / Q000628:therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery / Q000002:abnormalities; D018633:Pulmonary Atresia / Q000628:therapy; D011667:Pulmonary Veins / Q000002:abnormalities; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000009:adverse effects; D013771:Tetralogy of Fallot / Q000628:therapy; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000628:therapy*