Transcatheter Closure of Large-Sized Coronary Artery Fistula

We report our experience with the use of AMPLATZER?? Vascular Plug for the closure of coronary artery fistulas. Three patients (age: 3, 12, 14 years) were diagnosed with coronary fistulas (pulmonary-to-systemic blood flow ratio: 1.5 to 3). Two of the fistulas originated each, from the proximal right and left coronary artery and had maximal diameter 9 and 10 mm respectively; their narrowest diameter (6 mm) was proximal to their entrance into the right atrium creating a form of a saccular aneurysm.The third fistula (maximal diameter: 16 mm) originated from the circumflex artery and entered the right atrium with unobstructed flow (narrowest diameter: 8 mm). Interventional closure was considered optimal and the decision was made to use devices sized twice the size of the narrowest diameter of the fistulas (12, 12 and 16 mm respectively). An arterio-venous loop was established through the fistula by snaring an exchange guide-wire. All plugs were implanted from the femoral vein with the use of a seven or eight French guide catheter, reaching the narrowest segment of the fistula and leading to complete closure of the two fistulas, immediately after the procedure. The fistula arising from the circumflex artery that received the largest plug continued to have residual flow up to 12 months after the procedure, when follow-up echocardiography revealed its complete occlusion. We present and consider the use of the AMPLATZER?? Vascular Plug as a safe and effective method for the transcatheter closure of large-sized coronary fistulas. The plug potentially offers an alternative method to coil occlusion techniques as well as open heart surgery

Saw-tooth cardiomyopathy

We present an unusual case of cardiomyopathy in a two month old male infant with a grade-I systolic murmur. Echocardiographic examination disclosed left ventricular (LV), dysplasia with saw-tooth like inwards myocardial projections extending from the lateral walls towards the LV cavity. There was mild LV systolic dysfunction with apical hypokinesia. Cardiovascular magnetic resonance demonstrated in detail these cross bridging muscular projections originating from the inferior interventricular septum and lateral LV wall, along with areas of hypokinesis at the LV septum and apex in a noncoronary distribution, without any late gadolinium enhancement. We have termed this condition saw-tooth cardiomyopathy because of the very characteristic appearance