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Wu Z, Zeng C, Wang H, Shi W, Luo X. The chief culprit of intractable hypoxemia: a case report of rare pulmonary arteriovenous fistula complicated with giant hemangioma. J Cardiothorac Surg 2024; 19:78. [PMID: 38336790 PMCID: PMC10858512 DOI: 10.1186/s13019-024-02521-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Pulmonary arteriovenous fistula (PAVF) is a rare disease, which can lead to the direct return of unoxidized venous blood to pulmonary veins and left heart, resulting in right-to-left shunt leading to hypoxia. Long term, the right-to-left shunt will cause severe pathophysiological changes in the patient's body and pulmonary circulation, and the prognosis will be poor if PAVF is not treated timely. CASE PRESENTATION Here, we report the case of a 71-year-old man who presented with chest tightness and shortness of breath. After a series of examinations, PAVF and giant hemangioma were diagnosed, which are difficult to operate.Transcatheter interventional therapy was initiated. The patient recovered on the third day after operation and was discharged smoothly. During the long-term follow-up of nearly 4 years after discharge, the general condition and quality of life of the patient basically returned to normal. CONCLUSIONS PAVF is rare but very important clinical problem. When the clinical manifestations of persistent unexplained hypoxia appear, it is necessary to fully consider the possibility of PAVF. Once the diagnosis of PAVF is clear, timely treatment is recommended to avoid deterioration of the disease and affecting the prognosis.
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Affiliation(s)
- Zhangmin Wu
- Department of Cardiology, Army Medical Center of PLA, No. 10 Yangtze River Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Chunyu Zeng
- Department of Cardiology, Army Medical Center of PLA, No. 10 Yangtze River Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Hongyong Wang
- Department of Cardiology, Army Medical Center of PLA, No. 10 Yangtze River Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Weibin Shi
- Department of Cardiology, Army Medical Center of PLA, No. 10 Yangtze River Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Xiaoli Luo
- Department of Cardiology, Army Medical Center of PLA, No. 10 Yangtze River Branch Road, Yuzhong District, Chongqing, 400042, P.R. China.
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2
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Shu L, Luo L, Zuo Y. Attention to pulmonary arteriovenous fistula in a case of transient hypoxemia and cerebral infarction during pregnancy: a case report and literature review. BMC Pregnancy Childbirth 2023; 23:626. [PMID: 37653522 PMCID: PMC10469831 DOI: 10.1186/s12884-023-05946-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Pulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by pregnancy. If not diagnosed and treated promptly, pulmonary arteriovenous fistula can lead to respiratory failure, stroke, spontaneous hemothorax, or other fatal complications. CASE PRESENTATION A 29-year-old healthy pregnant woman presented with a transient drop in blood oxygen level of unknown cause during a routine examination at 34 weeks of gestation and during a cesarean section at 38 weeks of pregnancy. The patient's oxygen saturation quickly returned to normal and was not further investigated. On day 3 postpartum, the patient suddenly displayed slurred speech and right limb myasthenia. A head magnetic resonance imaging revealed cerebral infarction in the left basal ganglia. Subsequent computed tomography pulmonary arteriography revealed bilateral pulmonary arteriovenous fistula, which was likely the cause of cerebral infarction. The patient was transferred to the Department of Thoracic Surgery after one month of treatment and successfully underwent percutaneous embolization of pulmonary arteriovenous fistula. CONCLUSION Pulmonary arteriovenous fistula should not be neglected if a pregnant woman presents with transient hypoxemia and cerebral infarction. A transient decrease in pulse oxygen saturation that cannot be explained by common clinical causes can be an early warning sign of the disease. Early diagnosis and multidisciplinary management could improve the prognosis.
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Affiliation(s)
- Lijuan Shu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China
- The Research Units of West China (2018RU012) - Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, P.R. China
- Department of Obstetrics and Gynecology Intensive Care Unit, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China
| | - Linli Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, P.R. China
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China.
- The Research Units of West China (2018RU012) - Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China.
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3
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Zheng J, Wu QY, Zeng X, Zhang DF. Transient ischemic attack induced by pulmonary arteriovenous fistula in a child: A case report. World J Clin Cases 2023; 11:2009-2014. [PMID: 36998959 PMCID: PMC10044967 DOI: 10.12998/wjcc.v11.i9.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Cerebral ischemic stroke is attributed to paradoxical cerebral embolism. Pulmonary arteriovenous fistula (PAVF) is a rare potential cause of cerebral ischemic stroke, and cerebral ischemic stroke induced by PAVF in children is rare.
CASE SUMMARY We report a case of right PAVF that presented as a transient ischemic attack (TIA) in a 13-year-old boy. The patient underwent embolization therapy and remained clinically stable for 2 years after treatment.
CONCLUSION TIA induced by PAVF in children is rare, lacks typical clinical manifestations, and should not be ignored.
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Affiliation(s)
- Jun Zheng
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
| | - Qi-Yue Wu
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
| | - Xia Zeng
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
| | - Du-Fei Zhang
- Department of Pediatrics, Hainan Women and Children’s Medical Center, Haikou 570000, Hainan Province, China
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4
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Guvenc O, Odemis E, Saygi M, Onalan MA. Transcatheter management of life-threatening pulmonary arteriovenous fistula with extracorporeal membrane oxygenation support in an infant. Cardiol Young 2023; 33:498-501. [PMID: 36047509 DOI: 10.1017/S1047951122002724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary arteriovenous malformation is a rare disease leading to cyanosis, where there is a direct relation between the pulmonary artery and pulmonary vein without a capillary structure. Arteriovenous fistulae may be single or multiple. Clinical signs emerge depending on the size of the fistulae and amount of shunt. Due to the advancements in transcatheter devices and increased experience render enable the fistula embolisation procedure as an alternative to surgical treatment. Extracorporeal membrane oxygenation is used to support the patient haemodynamically and respirationally in cases of treatment-resistant, severe and revocable cardiac or pulmonary sufficiency. This paper presents an infant patient with pulmonary arteriovenous malformation, who had haemodynamic instability due to severe hypoxia and received successful transcatheter fistula embolisation via extracorporeal membrane oxygenation under emergency conditions.
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Matsuo S, Ozaki K, Matsuo Y, Takano T, Watanabe T, Sato T, Yagi T, Takayama T, Hoyano M, Yanagawa T, Ozawa T, Horii Y, Takano T, Kashimura T, Minamino T. Transcatheter coil embolization for large pulmonary arteriovenous fistulae through an artificial tricuspid ball valve. J Cardiol Cases 2022; 25:1-5. [PMID: 35024058 DOI: 10.1016/j.jccase.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
Pulmonary arteriovenous fistulae (PAFs) occur congenitally or are acquired. A PAF can cause hypoxemia, sudden death from rupture, abscess formation, and embolism. Treatment for PAF is transcatheter embolization or surgery. Transcatheter embolization is the first choice of treatment; however, this treatment is impossible to perform if a patient has had tricuspid or pulmonary valve replacement. In this paper, we describe a case of PAFs complicated with tricuspid valve replacement with a ball valve (which had been performed 40 years earlier) that was treated with transcatheter embolization. <Learning objective: Although the ball valve was discontinued more than 40 years ago, it is still the only mechanical valve that allows catheter passage. We report a case of successful treatment of pulmonary arteriovenous fistula by passing a catheter through a ball valve.>.
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Affiliation(s)
- Sei Matsuo
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuji Matsuo
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiki Takano
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tohru Watanabe
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuhiko Sato
- Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takuya Yagi
- Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tsugumi Takayama
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Hoyano
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takao Yanagawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takuya Ozawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yosuke Horii
- Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tohru Takano
- Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeshi Kashimura
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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6
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Kartik SV, Sasidharan B, Gopalakrishnan A, Kurup HKN, Krishnamoorthy KM, Sasikumar D, Thulaseedharan JV, Valaparambil A, Tharakan J, Sivasubramonian S. A Comparative Study of Invasive Modalities for Evaluation of Pulmonary Arteriovenous Fistula after Bidirectional Glenn Shunt. Pediatr Cardiol 2021; 42:1818-25. [PMID: 34331559 DOI: 10.1007/s00246-021-02670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
Development of pulmonary AV fistula (PAVF) after bidirectional glenn shunt (BDG) results in significant cyanosis, impaired exercise performance, and increased morbidity and mortality. We attempted to detect and quantify PAVF in post-BDG patients by saline contrast transesophageal echocardiography (TEE) and compare with pulmonary angiography and pulmonary vein oximetry. This was a prospective study done between 2017 and 2018. Twenty-five children who underwent BDG and planned for cardiac catheterization prior to Fontan completion were included in the study. All patients underwent pulmonary angiography, oximetry, and saline contrast TEE at the time of cardiac catheterization. Twenty-two patients had undergone unilateral BDG surgery and three were palliated by bilateral BDG. The mean oxygen saturation was 80 ± 5.2%. Thirteen patients (52%) had preserved antegrade pulmonary blood flow. Eighteen patients (72%) had PAVF by angiography and oximetry, while 19 (76%) had PAVF identified by contrast echocardiography. There was moderate correlation between the degree of pulmonary venous desaturation and grading of PAVF by contrast echocardiography. PAVF was predominantly located in the lower zones of the lungs. Higher grades of PAVF were not seen in patients with preserved antegrade flow after BDG. Angiographically detected PAVF showed a steady increase with increasing delay to cardiac catheterization from BDG. Significant reduction in systemic saturation was limited to advanced grades of PAVF in patients after BDG. Saline contrast TEE, pulmonary venous oximetry, and pulmonary angiography equally identified PAVF in patients after BDG. Prognostic utility of the same needs to be assessed by long-term follow-up of these subjects.
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7
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Li R, Zhou Y, Kang S, Kong F, Guan L, Zhao Y, Yin X. Declarations: management of a pulmonary arteriovenous fistulae by uniportal video-assisted thoracoscopic surgery: a case report. BMC Surg 2021; 21:101. [PMID: 33622276 PMCID: PMC7903596 DOI: 10.1186/s12893-021-01103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A pulmonary arteriovenous fistula (PAVF) is a rare condition that is associated with pulmonary arteriovenous malformation (PAVM). Few reports have described managing PAVMs using uniportal video-assisted thoracoscopic surgery (VATS). CASE PRESENTATION A 13-year-old child with PAVF in the left inferior pulmonary artery was treated by uniportal VATS with left lower lobectomy. After surgery, hemoptysis did not recur and there were no postoperative complications. Six months after the operation, postoperative review of computerized tomography showed no recrudescence of PAVF. CONCLUSIONS PAVF is a rare case that should be diagnosed and treated early. 3D- computerized tomography (CT) reconstruction is useful for diagnosis and preoperative assessment. The case shows that PAVF can be managed with uniportal VATS.
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Affiliation(s)
- R Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Y Zhou
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - S Kang
- Department of Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - F Kong
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - L Guan
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Y Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - X Yin
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.
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8
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Mitsui S, Tauchi S, Tanaka Y, Tobe S. Pulmonary arteriovenous fistula ruptured in an adolescent girl 1 week after her mother's rupture: a report of a case. Gen Thorac Cardiovasc Surg 2020; 69:130-132. [PMID: 32556901 DOI: 10.1007/s11748-020-01410-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/10/2020] [Indexed: 11/27/2022]
Abstract
A 14-year-old girl was diagnosed with hemothorax associated with pulmonary arteriovenous fistula rupture, and emergency surgery was performed. One week before her surgery, her mother at 32 weeks of gestation underwent emergency surgery for hemothorax caused by pulmonary arteriovenous fistula rupture. Both were diagnosed with hereditary hemorrhagic telangiectasia. The indications for treatment of pulmonary arteriovenous fistulas in young patients remain controversial because the risk of complications concerning pulmonary arteriovenous fistula is lower in young patients than in adult patients. We recommend that aggressive treatment should be performed for pulmonary arteriovenous fistulas in patients with hereditary hemorrhagic telangiectasis with a family history of pulmonary arteriovenous fistula rupture even if the patient is asymptomatic and young, because such patients may have a high risk of pulmonary arteriovenous fistula rupture.
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Affiliation(s)
- Suguru Mitsui
- Department of Thoracic Surgery, Akashi Medical Center, 743-33 Okubocho Yagi, Akashi, Hyogo, 674-0063, Japan
| | - Shunsuke Tauchi
- Department of Thoracic Surgery, Akashi Medical Center, 743-33 Okubocho Yagi, Akashi, Hyogo, 674-0063, Japan.
| | - Yugo Tanaka
- Division of Thoracic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, 650-0017, Japan
| | - Satoshi Tobe
- Department of Thoracic Surgery, Akashi Medical Center, 743-33 Okubocho Yagi, Akashi, Hyogo, 674-0063, Japan
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9
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Contegiacomo A, Del Ciello A, Rella R, Attempati N, Coppolino D, Larici AR, Di Stasi C, Marano G, Manfredi R. Pulmonary arteriovenous malformations: what the interventional radiologist needs to know. Radiol Med 2019; 124:973-88. [PMID: 31209790 DOI: 10.1007/s11547-019-01051-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
Pulmonary arteriovenous malformations (PAVMs) or fistulas are rare direct pathological connections between pulmonary arterial and venous circulation. Most of PAVMs are congenital and closely associated with hereditary hemorrhagic telangiectasia, but acquired PAVMs have also been described in the literature. Diagnosis of PAVMs is a priority for clinicians, in order to prevent potentially fatal events such as cerebrovascular stroke, systemic septic embolization, hemoptysis and hemothorax. In this scenario, the radiologist plays a key role in both diagnostic and therapeutic workups of PAVMs: Chest X-ray, computed tomography and magnetic resonance are effective tools for PAVMs identification and confirmation of the suspected diagnosis. Furthermore, imaging modalities provide most of the elements for PAVMs classification according to their angioarchitecture (simple and complex) and help the clinicians in establishing which lesion requires prompt treatment and which one will benefit of imaging follow-up alone. Endovascular management of PAVMs has grown up as the first-line treatment in respect of surgery during last decades, showing lower risk of intra- and post-procedural complications and offering a wide number of treatment options and materials, ensuring effective management in virtually any clinical situation; interventional treatment aims to exclude PAVMs from pulmonary circulation, and specific technique and embolic agents should be selected according to pre-treatment imaging, in order to obtain the best procedural outcome. This paper proposes a review of the clinical and radiological features that a radiologist needs to know for PAVMs diagnosis and proper management, also showing an overview of the most common endovascular treatment strategies and embolization materials.
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Xie L, Li Y, Jiang X, Zhao J, Xiao T. A 10-year-old boy with dyspnea and hypoxia: abernathy malformation masquerading as pulmonary arteriovenous fistula. BMC Pediatr 2019; 19:55. [PMID: 30744582 PMCID: PMC6371454 DOI: 10.1186/s12887-019-1422-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 01/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Abernethy malformation is an extremely rare congenital malformation characterised by an extrahepatic portosystemic shunt. Children with Abernathy malformation can develop hepatopulmonary syndrome (HPS) with pulmonary arteriovenous fistulas (PAVF) or pulmonary hypertension. PAVF manifests as central cyanosis with effort intolerance. We report a case of PAVF in a Ten-year-old Boy. Persistent symptoms identified Abernathy malformation as the cause of progressive symptoms and current understanding of this rare malformation is reviewed. Case presentation A case of 10-year-old boy with Abernethy malformation complicated with HPS initially managed as PAVF was presented. Selective lung angiography showed a typical diffuse reticular pattern on right lower lung, which suggested PAVF. However, cyanosis was not improved post transcatheter coil embolization. Then, liver disease was considered although the patient had normal aspartate aminotransferase and alanine aminotransferase. The significantly elevated serum ammonia was attracted our attention. Abdominal computed tomography also exhibited enlarged main portal vein (MPV), cirsoid spleen vein, and superior mesenteric vein (SMV). Angiography with direct opacification of the SMV with a catheter coming from the inferior vena cava (IVC) and going to the SMV via the shunt vessel (SHUNT) between the MPV and IVC. Occlusion the IVC with an inflated balloon, injection of contrast medium via a catheter placed in the SMV, MPV was showed and absence of intrahepatic branches. Abernethy malformation IB type is finally confirmed. Conclusions Abernethy malformation is an unusual cause for development of PAVF and cyanosis in children. Clinicians must be suspicious of Abernethy malformation complicated with HPS. If patients have abnormal serum ammonia and enlarged MPV in abdominal CT, cathether angiography should be done to rule out Abernethy malformation.
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Affiliation(s)
- Lijian Xie
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Yun Li
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Xunwei Jiang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Jian Zhao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Tingting Xiao
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiaotong University, No. 355 Luding Road, Shanghai, 200062, China.
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11
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Li C, Hao S, Wang J, Gao Z, Ji N. Severe cerebral abscess associated with pulmonary arteriovenous fistula: case report and literature review. Chin Neurosurg J 2018; 4:30. [PMID: 32922891 PMCID: PMC7398252 DOI: 10.1186/s41016-018-0137-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022] Open
Abstract
Background A rare case of cerebral abscess concurrent with pulmonary arteriovenous fistula (PAVF), hyperhemoglobinemia, and hypoxemia was reported. Case presentation A 37-year-old man was admitted with a headache, nausea, vomiting, fever, and numbness of the left cheek and upper limb for 10 days. Cerebral magnetic resonance imaging (MRI) shows the lesion in his right frontal lobe. Blood gas analysis indicated lower blood oxygen saturation level, and blood routine test showed hemoglobin elevation. Craniotomy for the lesion and decompressive craniotomy were performed. Brain abscess was confirmed by pathology examination. The chest computed tomography angiography (CTA) revealed a pulmonary arteriovenous fistula (PAVF) in his right lower lung. After 1 month, embolization of PAVF was performed. Anoxic symptom improved after surgery. Cranioplasty was performed after 7 months. Conclusion The author reported a rare case of cerebral abscess associated with pulmonary arteriovenous fistula. Brain abscess, hyperhemoglobinemia, and hypoxemia might be secondary to PAVF. Treatment of patients includes not only craniotomy for abscess removal but also embolization of PAVF which can prevent recurrence of brain abscess.
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Affiliation(s)
- Chunzhao Li
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Shuyu Hao
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Jiangfei Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Zhixian Gao
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
| | - Nan Ji
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brian Tumor, Beijing, China.,China National Clinical Research Center for Neurological Diseases Beijing, Beijing, China
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12
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Sousa S, Vasco Costa N, Carmona C, Coimbra É, Pita F. Recurrent Stroke in a Young Woman with a Single Pulmonary Arteriovenous Fistula: An Unusual Association. Case Rep Neurol 2018; 9:293-298. [PMID: 29422852 PMCID: PMC5803734 DOI: 10.1159/000484682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Cryptogenic stroke is present in about 40% of ischemic stroke patients. Extracardiac shunt related to pulmonary arteriovenous fistula (PAVF) could be a rare potential risk factor for embolic stroke. Most PAVFs are multiple, congenital, and associated with hereditary conditions. On the other hand, isolated PAVFs are rare conditions and an uncommon cause of cryptogenic stoke. Case Report We describe a case of a young woman without history of respiratory diseases or vascular risk factors, who presented with acute onset of transitory aphasia and right hemiplegia. She had a history of a transient ischemic attack, 3 years before, and migraine headaches. Brain MRI showed an acute cortical ischemic lesion and a chronic ischemic lesion. Diagnostic workup with transcranial Doppler ultrasonography revealed a significant right-to-left shunt with curtain pattern, and echocardiogram did not show structural abnormalities. An isolated small PAVF was diagnosed on pulmonary angiogram. Despite the rare association between isolated small PAVF and stroke, we decided to treat it with coil embolization because of recurrence of stroke, cortical lesions suggestive of embolic source, significant right-left shunt, and risk of future complications. Conclusions This case highlights the importance of search, identification, and interpretation of causes of cryptogenic strokes to better choose therapy to reduce the stroke recurrence risk. Although unusual, PAVF detection is a treatable cause of stroke and the therapeutic decisions should take into account the characteristics of the PAVF and the degree of suspicion regarding the cause-effect relationship between PAVF and stroke.
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Affiliation(s)
- Sandra Sousa
- Department of Neurology, Hospital de Cascais, Cascais, Portugal
| | - Nuno Vasco Costa
- Interventional Radiology, Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Cátia Carmona
- Department of Neurology, Hospital de Cascais, Cascais, Portugal
| | - Élia Coimbra
- Interventional Radiology, Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Fernando Pita
- Department of Neurology, Hospital de Cascais, Cascais, Portugal
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13
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Shang HW, Sun SB, Ma GY, Mei XM, Li C, Yang K. A ruptured pulmonary arteriovenous fistula after laparoscopic operation. Chin J Traumatol 2017; 20:359-361. [PMID: 29050800 PMCID: PMC5832461 DOI: 10.1016/j.cjtee.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/11/2017] [Accepted: 07/26/2017] [Indexed: 02/04/2023] Open
Abstract
Pulmonary arteriovenous fistula (PAVF) is a rare anomaly in the lung, and hemothorax or massive hemoptysis due to spontaneous rupture of the fistula sac is even rarer. The patient described here was a 47-year-old woman who presented with massive hemoptysis resulting from the rupture of her PAVF just after laparoscopic operation. To our knowledge, this may be the first case ever reported that the rupture of PAVF may be correlated with a laparoscopic operation. The patient survived without adverse events after emergency pulmonary lobectomy.
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Affiliation(s)
- Hong-Wei Shang
- Department of Cardiothoracic Surgery, Chinese PLA No. 254 Hospital, Tianjin, China,Corresponding author.No.60, Huangwei RdHebei DistrictTianjin300142China
| | - Sheng-Bin Sun
- Department of Cardiothoracic Surgery, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Guang-Yao Ma
- Department of Cardiothoracic Surgery, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Xing-Ming Mei
- Department of Pathology, Chinese PLA No.254 Hospital, Tianjin, China
| | - Chao Li
- Department of Cardiothoracic Surgery, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Kang Yang
- Department of Cardiothoracic Surgery, Chinese PLA No. 254 Hospital, Tianjin, China
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14
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Kim SY, Kim ER, Bang JH, Kim WH. Development of a Pulmonary Arteriovenous Fistula after a Modified Glenn Shunt in Tetralogy of Fallot and Its Resolution after Shunt Takedown in a 57-Year-Old Patient. Korean J Thorac Cardiovasc Surg 2017; 50:215-219. [PMID: 28593160 PMCID: PMC5460971 DOI: 10.5090/kjtcs.2017.50.3.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/17/2016] [Accepted: 09/18/2016] [Indexed: 11/29/2022]
Abstract
Pulmonary arteriovenous fistula (PAVF) is a complication of the Glenn shunt. A 57-year-old tetralogy of Fallot (TOF) patient, who had undergone a Glenn shunt and TOF total correction, complained of dyspnea and cyanosis. PAVFs were present in the right lung, and right lung perfusion was nearly absent. After coil embolization, takedown of the Glenn shunt, and reconstruction of the right pulmonary artery, the patient’s symptoms were relieved. Extrapulmonary radioisotope uptake caused by the PAVFs shown in lung perfusion scans decreased, and right lung perfusion increased gradually. Although the development and resolution of PAVFs after a Glenn shunt have been reported in the pediatric population, this may be the first report on this change in old age.
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Affiliation(s)
- Sang Yoon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Eung Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Ji Hyun Bang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
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15
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Ichiki Y, Kawasaki J, Hamatsu T, Suehiro T, Koike M, Tanaka F, Sugimachi K. Surgical management of pulmonary arteriovenous fistula in a female patient. Int J Surg Case Rep 2015; 7C:54-7. [PMID: 25579986 PMCID: PMC4336401 DOI: 10.1016/j.ijscr.2014.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 12/07/2014] [Accepted: 12/07/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction We herein describe a rare case of a pulmonary arteriovenous fistula (PAVF). Presentation of case The patient was a 20-year-old asymptomatic female, admitted to our hospital because of an abnormal shadow in the right lung field on chest X-rays. Chest computed tomography (CT) revealed two nodules with well-defined margins in the right upper and lower lobes. Contrast-enhanced three-dimensional CT (3D-CT) revealed two enhanced solitary lung nodules which were connected with linear structures suggestive of feeding arteries and drainage veins, respectively. Based on these findings, we made a preoperative diagnosis of PAVF. We performed partial pulmonary resection of the right upper and lower lobes by video-assisted thoracoscopic surgery (VATS). The histopathological findings revealed small and medium-sized vascular channels composed of arteries with mild and irregularly thickened muscle walls and juxtaposed or seemingly anastomosing dilated veins. Based on these findings, a diagnosis of PAVF was confirmed. The patient had an uneventful postoperative course. Discussion A PAVF is often associated with various complications, and pregnancy could be a risk factor for these complications because of the increase in the shunt fraction. Females with known PAVF should be maximally treated prior to becoming pregnant as complications of PAVF during pregnancy can have devastating consequences. Therefore, we thought that treatment should be recommended in this case in the event she might later choose to become pregnant. Conclusion Surgical resection using VATS for a limited number of ipsilateral isolated pulmonary arteriovenous fistulae is recommended due to its safety, low recurrence and low mortality rate.
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Affiliation(s)
- Yoshinobu Ichiki
- Department of Chest Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan.
| | - Junji Kawasaki
- Department of Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan
| | - Takayuki Hamatsu
- Department of Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan
| | - Taketoshi Suehiro
- Department of Emergency, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan
| | - Makiko Koike
- Department of Radiology, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Keizo Sugimachi
- Department of Surgery, Onga Nakama Medical Association Onga Hospital, Onga-gun, Japan
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16
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Abstract
An eight-year-old boy was evaluated for unexplained hemoptysis and cyanosis. A contrast echocardiogram was suggestive of pulmonary arteriovenous fistula. Further evaluation revealed persistent ductus venosus (PDV) and aortopulmonary collaterals. Both the PDV and aortopulmonary collaterals were closed percutaneously. PDV is amenable for device closure after detailed anatomical evaluation. Prior to closure, it is important to ensure adequate portal vein arborization into the liver and normal portal pressure after test balloon occlusion.
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Affiliation(s)
- Venkateshwaran Subramanian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Sivasankaran Sivasubramonian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bijulal Sasidharan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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17
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Zalewski NL, Coon EA, Cetta F, Taggart NW, Flemming KD. Successful endovascular repair of an unusual right-to-left shunt presenting with cerebral ischemia. J Clin Neurosci 2014; 21:1257-8. [PMID: 24472238 DOI: 10.1016/j.jocn.2013.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 11/25/2022]
Abstract
Ischemic stroke due to congenital cardiopulmonary vasculature anomalies is rare in adults. We report a 54-year-old man with a stroke due to a unique right-to-left shunt who underwent successful endovascular treatment. This patient developed acute onset of right arm weakness with facial droop and aphasia which improved after intravenous thrombolysis. An MRI showed acute cerebral ischemia in the left middle cerebral artery and left posterior cerebral artery distribution. The patient developed recurrent stroke symptoms during agitated saline injection while undergoing a transthoracic echocardiogram which showed right-to-left shunting. Chest CT scan and conventional angiography revealed near occlusion of the superior vena cava. Head and upper limb venous return drained via a large left vertical vein into an anomalous left pulmonary vein into the left atrium. He underwent endovascular surgery to relieve the superior vena cava obstruction and to occlude the source of right-to-left shunt. While rare, congenital cardiopulmonary vascular anomalies may result in ischemic stroke in adults. CT angiography may be necessary to evaluate cardiopulmonary vasculature when right-to-left shunting is discovered on echocardiography in the setting of ischemic stroke. With large right-to-left shunts, agitated saline should be avoided.
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Affiliation(s)
- Nicholas L Zalewski
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Elizabeth A Coon
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Frank Cetta
- Department of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
| | | | - Kelly D Flemming
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
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Tanaka R, Yoshioka K, Takeda M, Muranaka K, Sone M, Suzuki M, Ehara S. Usefulness of dynamic volume scanning with 320-row CT in detecting recanalization of pulmonary arteriovenous fistula after coil embolization. Springerplus 2013; 2:169. [PMID: 23741638 PMCID: PMC3664737 DOI: 10.1186/2193-1801-2-169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/13/2013] [Indexed: 12/04/2022]
Abstract
Pulmonary arteriovenous fistula is a congenital and rarely acquired anomalous direct communications between pulmonary arteries and veins. Transcatheter embolization using metallic coil or detachable balloon is one of the common treatment procedure. However, recanalization after the embolization is one of the concern and its differentiation from the retrograde filling via pulmonary vein is difficult except using invasive angiography. We report a case with recanalized pulmonary arteriovenous fistula non-invasively detected by dynamic CT angiography with 320-rows multi detector CT. A 45-year-old women who had underwent coil embolization for pulmonary arteriovenous fistula was examined with dynamic CT angiography and antegrade contrast enhancement of the fistula was noted. The recanalization through the embolized artery was confirmed by digital subtraction angiography, and the second coil embolization was performed. The follow-up dynamic CT angiography at three months after the second procedure found the retrograde enhancement of aneurysmal sac and no antegrade shunt. The dynamic CT angiography was useful for the detect the recanalization of pulmonary arteriovenous fistula. Delayed pulmonary artery recanalization was reported to be observed in 5- 10% of cases as a complication after the successful occlusion of segmental pulmonary artery. Lack of change in aneurysmal diameter of pulmonary arteriovenous fistula demonstrated by CT was reported as the result of persistent aneurysmal perfusion or aneurysmal thrombosis. However, the retrograde filling of aneurysmal sac via pulmonary vein or remnant collateral pathway to the pulmonary arteriovenous fistula were also considered. Therefore, before the invasive procedure, we performed dynamic CT angiography to detect the flow direction and pathway to the pulmonary arteriovenous fistula. Using dynamic CT angiography, we could obtain hemodynamic information through the aneurysmal sac of pulmonary arteriovenous fistula and decide to proceed to the invasive embolotherapy. Prospective perfusion CT scan could be an alternative to invasive angiography in the initial follow-up after the embolotherapy or in the cases with the recanalization of pulmonary arteriovenous fistula.
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Affiliation(s)
- Ryoichi Tanaka
- Department of Radiology, Iwate Medical University, 19-1Uchimaru, Morioka, Iwate, 020-8505 Japan
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