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CASE RESOLUTION Traditionally, the percutaneous closure of this type of defects has been performed using coil embolization procedures and ductus arteriosus closure devices. However, since the appearance of the Amplatzer Vascular Plug (Abbott, United States) its effectiveness in the embolization of certain types of collaterals and fistulae in congenital heart diseases has been recognized.1 Amplatzer Septal Occluders devices (Abbott, United States)—designed for septal defect closure—can be used in certain situations to close non-septal defects, among them, pulmonary systemic fistulae2 and, in general, communications between systemic and pulmonary circulation. Once the fistula between the pulmonary artery trunk and Fontan circulation was diagnosed, the procedure was performed under general anesthesia, and fluoroscopy and transesophageal echocardiography guidance. Cardiac catheterization was performed via right femoral vein (6-Fr) and right femoral artery (5-Fr). The retrograde ascending aortic route was used. The left ventricle was accessed and a 0.014 in moderate support guidewire (PT2) (Boston, United States) was used to pass antegradely the subpulmonary stenosis, and the pulmonary trunk until the superior vena cava passing through the fistula. After capturing the border of the guidewire using a 20 mm Gooseneck snare (EV3), an arteriovenous loop was created to facilitate the placement of an 0.035 in Emerald guidewire (CORDIS, United... |
