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Published on: November 24, 2014
Transcatheter closure of coronary artery fistulae using the Amplatzer Duct Occluder
Sarina K Behera1, Saar Danon, Daniel S Levi
1Division of Pediatric Cardiology, Mattel Children's Hospital at UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Insights
The Amplatzer Duct Occluder (ADO) effectively closes coronary artery fistulae (CAF) in pediatric and adult patients. This transcatheter approach using the ADO offers advantages for significant CAF occlusion.
Area of Science:
- Interventional Cardiology
- Congenital Heart Disease
- Vascular Surgery
Background:
- Transcatheter closure of coronary artery fistulae (CAF) using coils is established.
- Newer devices may enhance control, reduce device number, and improve occlusion rates.
Purpose of the Study:
- To evaluate the Amplatzer Duct Occluder (ADO) for transcatheter closure of significant coronary artery fistulae (CAF).
Main Methods:
- Retrospective review of patients with CAF undergoing cardiac catheterization (July 2002–August 2005).
- ADO placement in 6 patients using an antegrade approach with a long sheath.
- Follow-up ranged from 3 to 14 months.
Main Results:
- Complete CAF occlusion was achieved in 5 of 6 patients; one had a minimal residual shunt with resolution of chamber enlargement.
- All patients were free of fistula-related murmurs post-procedure.
- Two symptomatic patients experienced resolution of congestive heart failure.
Conclusions:
- The Amplatzer Duct Occluder (ADO) is suitable for transcatheter closure of significant coronary artery fistulae (CAF).
- Advantages include an antegrade approach, single-device use, and effective occlusion.
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.
