Transcatheter closure of large congenital coronary-cameral fistulae with amplatzer devices

Objectives: To report on the methods and results of treatment of large congenital coronary-cameral fistulae by transcatheter closure with Amplatzer devices. Background:Large coronary-cameral fistulae cause a steal phenomenon from the normal coronary circulation. Surgical closure is an option. However, transcatheter methods allow for temporary occlusion, definition of anatomy, and online assessment of successful closure. Amplatzer devices are compact occluders that can be fully delivered, collapsed, and repositioned until a satisfactory position is attained. Methods: Coronary and fistula anatomy were defined by selective coronary angiography with or without temporary occlusion. Device closure of the fistula was performed at the most distal point accessible, often from the cameral side using an arteriovenous loop method. Results: Ten patients of median age 2.6 years (0.5-52.2) and weight 14.4 kg (6.1-67) underwent an attempt at transcatheter closure of a large fistula. In nine patients, the fistula was closed successfully with a device. There were no complications. Conclusions: Transcatheter closure of coronary-cameral fistula with Amplatzer devices is safe and effective.