Transcatheter closure of a large coronary arteriovenous fistula using the new Amplatzer™ duct occluder

Hakim, Fakhri; Madani, Awni; Goussous, Yousef; Cao, Qi‐Ling; Hijazi, Ziyad M.

doi:10.1002/(sici)1097-0304(199810)45:2<155::aid-ccd11>3.0.co;2-k

Cited by 43 publications

(22 citation statements)

References 9 publications

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“…Surgical closure usually is performed on a beating heart from the epicardial surface, is associated with low mortality and morbidity, and has excellent immediate and long-term outcomes. 81 Various transcatheter occlusion techniques have been used [82][83][84] with excellent outcomes for fistulas with shorter, less tortuous courses.…”

Section: Indications For Interventionmentioning

confidence: 99%

Pathophysiology of Congenital Heart Disease in the Adult

2008

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Section: Indications For Interventionmentioning

confidence: 99%

Pathophysiology of Congenital Heart Disease in the Adult

2008

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“…In recent years, despite the satisfactory results of surgery, less invasive percutaneous methods have become the treatment of choice. Several devices have been used, including Gianturco's coils, disposable coils, disposable balloons, alcohol polyvinyl, double umbrellas, and the Amplatzer occluder [4][5][6][7][8] . The risks of percutaneous treatment include myocardial infarction and embolization of the devices used for other extracardiac vascular structures.…”

Section: Discussionmentioning

confidence: 99%

“…Several fistulae arising from both coronaries and ending in the pulmonary artery, such as in our patient's case, are rare clinical entities 2 . Fistulae with marked hemodynamic repercussions leading to symptoms of heart failure and thoracic pain are, classically, treated with surgery 3 ; however, catheter occlusion is currently increasing in frequency [4][5][6][7][8] . …”

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Volumosas fístulas de ambas coronárias para a artéria pulmonar: embolização percutânea com micro-molas e balões destacáveis

Portela¹,

Vale²,

Bastos³

et al. 2005

Arq. Bras. Cardiol.

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A 43-year-old symptomatic woman (dyspnea and palpitation) had multiple coronary-pulmonary artery fistulae with high output; percutaneous embolization was successfully performed using controlled-release microcoils and disposable balloons.Coronary fistulae are communications between these arteries and the cardiac cavities or other mediastinal vessels; frequently, they are alterations in embryo development 1 . Several fistulae arising from both coronaries and ending in the pulmonary artery, such as in our patient's case, are rare clinical entities 2 . Fistulae with marked hemodynamic repercussions leading to symptoms of heart failure and thoracic pain are, classically, treated with surgery 3 ; however, catheter occlusion is currently increasing in frequency [4][5][6][7][8] . Case ReportA 43-year-old woman was referred to the hospital because of frequent episodes of palpitations and exercise-related dyspnea, with symptoms progressing in recent years. Specific clinical examination revealed a continuous cardiac murmur, heard at the left sternal border at the third and fourth intercostal spaces. Twelvelead electrocardiography revealed complete left bundle-branch block. Echocardiographic Doppler performed at another hospital showed large patent ductus arteriosus and pulmonary artery hypertension. The patient was referred for hemodynamic study because of this diagnosis. Manometry revealed a mild increase in pressure in the right chamber and pulmonary artery. A pulse oximetric recording peaked at the level of the pulmonary artery trunk. Patent ductus arteriosus was not found. Cardiac scintigraphy demonstrated large right coronary ( fig.1) and left coronary fistulae ( fig. 2) in the pulmonary artery.Percutaneous embolization was performed, using the right femoral artery for Access with a JR 4 6F guidewire catheter (Cordis, brite tip) for the right coronary and a JL 4 6F for the left coronary.After venous administration of 5000 U unfractionated heparin, a large fistula of the right coronary ostium was catheterized selectively (Excelsior microcatheter, Boston Scientific). Controlled-release coils were used to completely occlude fistula (MicroPlex, Microvention). Microcatheters were used to perform catheterization of the 2 large fistulae in the proximal and medium third of the anterior descending artery, the fistula being successively occluded with the same type of microcoils. These coils are produced by Microvention. New platinum microcoils were introduced into the market in 2002 for the embolization of brain aneurysms. We used 11 devices for the embolization of the fistulae: 2 microplex 4mm/8cm, 2 microplex 6mm/15cm, 2 microplex 8mm/20cm, 1 microplex 4mm/10cm, 1 microplex 5mm/12cm, 1 microplex 7mm/ 18cm, 1 microplex 7mm/30cmm, and 1 microplex 9/30cm ( fig. 3).A residual flow was left in the right coronary fistula by a lateral branch emerging before the site where the coils were released. The patient under local anesthesia tolerated the procedure well. Distal embolization was not observed for the coronary branches.After the ...

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“…The ADO has shown promising short-term results for patent ductus arteriosus closure [6]. Two recent reports describe the use of Amplatzer devices for successful closure of a large circumflex artery-to-RA coronary fistula (ductal occluder) [7] and a residual hepatic vein-to-LA communication after a Fontan operation (septal occluder) [8]. We think that the ADO could be used in any instance where a moderately large vessel requires occlusion.…”

Section: Discussionmentioning

confidence: 99%