Percutaneous closure of coronary fistulae using different devices

Two-month baby recently treated with closure of perimembranous interventricular communication with congestive clinical signs in the postoperative period and echocardiographic suspicion of possible right coronary artery-to-right ventricle fistula confirmed on the cardiac computed tomography and catheterization with nonselective coronary angiography. Parents' informed consent was obtained for the dissemination of the case. A large coronary fistula—eligible for percutaneous closure—can be seen exiting the right coronary artery marginal branch and entering the right ventricular cavity with great dilatation of the right coronary artery proximal segment (figure 1). A 4-Fr carrier catheter is inserted into the right coronary artery and a guidewire is advanced towards the right ventricle. Assisted by an angioplasty balloon, the carrier catheter is then advanced towards the fistula proximal zone where eventually a 4 × 6 Amplatzer Vascular Plug (AVP4) device (Abbott, United States) is delivered resulting in the total occlusion of the defect with no interference with the distal right coronary artery (figure 2).