Systemic artery to pulmonary artery fistula associated with mitral regurgitation: successful treatment with endovascular embolization

Chest wall systemic artery-to-pulmonary artery vascular malformation treated by embolization of feeders and drainers: A case report

A 74-year-old woman presented with progressive dyspnea. Computed tomography revealed a large systemic artery-to-pulmonary artery vascular malformation (VM) on the right chest wall. Embolization of the VM was performed. First, the main drainers of the VM were retrogradely selected from the segmental pulmonary arteries and embolized using microcoils. Second, 2 main feeders of the VM were selected and embolized with N-butyl cyanoacrylate. Thus, marked flow reduction in the VM was achieved, and the patient's symptom improved dramatically. We believe that embolization of both feeders and drainers is an effective technique for treatment of a chest wall systemic artery-to-pulmonary artery VM.

Endovascular Treatment of a Systemic-to-Pulmonary Artery Fistula: A Case Report

Systemic-to-pulmonary artery fistulas are rare. This condition may be congenital, post-traumatic, or post-inflammatory and can cause infection, hemorrhage, or pulmonary hypertension. Here, we report a case of an intercostal-to-pulmonary artery fistula, incidentally detected during the evaluation of dyspnea in a 67-year-old female. Retrograde transcatheter coil embolization in a dilated draining pulmonary artery was initially attempted. However, another draining pulmonary artery developed after 5 months. The intercostal arteries or systemic feeders were successfully embolized through a transarterial access. At the 10-month follow-up, the abnormally dilated vessels had regressed, and dyspnea had improved. Sequential or simultaneous retro- and antegrade transcatheter embolization may successfully treat pleural arterio-arterial fistulas.

Mitral valve surgery in a patient with systemic artery-to-pulmonary artery fistulas

We report the case of a 68-year-old woman with severe mitral valve regurgitation and concomitant multiple systemic artery-to-pulmonary artery fistulas. Endovascular embolization of the fistulas was unable to control her heart failure, and mitral valve replacement was also performed. Steps were taken during mitral valve surgery to ensure an adequate operative field in the left atrium, despite the large volume of in-pouring blood from the pulmonary vein.