Fig. 4.

A. Selective angiography in the descending thoracic aorta of the 39 year old patient described in Figs. 2 and 3A demonstrates a large aortopulmonary collateral (APC) that required coil embolization (B) to decrease bleeding risk during transplantation. C. Veno-venous collateral from the innominate vein to the left sided pulmonary veins in the patient described in Fig. 3B. D. Amplatzer vascular plug implantation results in complete occlusion of flow. The venous collaterals could contribute to the heavy bleeding seen during Fontan transplantation and therefore the protocol at the Ahmanson/UCLA ACHD program is to occlude both arteriopulmonary and veno-venous collaterals prior to listing for transplantation