Initial experience with the Amplatzer Vascular Plug IV in congenital heart disease: coronary artery fistula and aortopulmonary collateral artery embolization.

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.

CONCLUSION

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.