Diagnosis and therapeutics of pulmonary arteriovenous fistula in childhood. Case report and review of the literature

Gianisella, Roberto Bartolomeu; Filho, Raul Ivo Rossi; Zielinsky, Paulo

doi:10.1590/s0066-782x2001000900008

Cited by 9 publications

(21 citation statements)

References 18 publications

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“…2 A forma congênita tem duas variedades: a) angioma cavernoso, geralmente alimentado por um ou mais ramos tortuosos e dilatados da artéria pulmonar; e b) telangiectasia capilar, formada por uma rede de capilares, geralmente associada a telangiectasia hemorrágica hereditária ou síndrome de Rendu-Osler-Weber (displasia vascular autossômica dominante com penetrância variá-vel, caracterizada por múltiplas telangiectasias, causando hemorragias recorrentes). 4 Mais de 80% das FAVPs são congênitas, enquanto as formas adquiridas são secundárias a trauma, cirurgia torácica, cirrose hepática avançada, carcinoma metastático, estenose mitral e amiloidose sistêmica. 5,6 A FAVP descrita neste relato apresentava etiologia congênita do tipo angioma cavernoso.…”

Section: Discussionunclassified

Oclusão de fístula arteriovenosa pulmonar com plug vascular em paciente com embolia cerebral paradoxal prévia

Faria¹,

Garzon²,

Jacob³

2011

Rev. Bras. Cardiol. Invasiva

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Fístula arteriovenosa pulmonar (FAVP), uma rara anormalidade vascular, é uma comunicação direta entre a artéria e a veia, sem a interposição do leito capilar, representando shunt extracardíaco direito-esquerdo.1 Quando significativa, pode causar sinais e sintomas clínicos, tais como fadiga fácil, dispneia de esforço, cianose, hemoptise e complicações importantes como abscesso cerebral, ataque isquêmico transitório e acidente vascular encefálico. 2Neste artigo, descrevemos o caso de uma paciente com FAVP que apresentou dois episódios de acidente isquêmico transitório (AIT) prévios, sendo submetida a oclusão percutânea do defeito com Amplatzer TM ABSTRACT Occlusion of Pulmonary Arteriovenous Fistula Using Vascular Plug in a Patient with Previous Paradoxal Cerebral EmbolismPercutaneous transcatheter embolization has become the treatment of choice for pulmonary arteriovenous fistulae (PAVFs), replacing surgical intervention in most cases. Classical devices, such as intravascular coils and detachable balloons, have proven to be successful for percutaneous occlusions of small or medium-sized PAVFs; however, they are not ideal for larger and high flow fistulae due to the risk of embolization to systemic circulation. The case of a 49-year-old woman with high flow pulmonary fistula and previous neurological ischemic manifestations undergoing successful transcatheter closure with an Amplatzer TM Vascular Plug II, a device designed for occlusion of vascular abnormalities, is reported. KEY-WORDS:Arteriovenous fistula. Pulmonary artery. Embolization, therapeutic. Coronary occlusion. RESUMOA embolização percutânea transcateter tornou-se o tratamento de escolha para fístulas arteriovenosas pulmonares (FAVPs), na maioria dos casos em substituição à intervenção cirúr-gica. Os dispositivos clássicos, tais como coils intravasculares e balões destacáveis, provaram ser um sucesso para oclusões percutâneas de FAVPs pequenas ou médias; porém, não são ideais nas fístulas maiores e de alto fluxo pelo risco de embolização para a circulação sistêmica. Relatamos o caso de uma mulher de 49 anos de idade com FAVP de alto fluxo e manifestações neurológicas isquêmicas prévias, submetida com sucesso a fechamento percutâneo com Amplatzer RELATO DO CASOPaciente do sexo feminino, com 49 anos de idade, apresentou quadro de paresia e parestesia em membro superior direito há três anos, que regrediu em 24 horas, sendo atendida em outro serviço em que foi confirmado diagnóstico de AIT por meio de ressonân-cia nuclear magnética. Ainda nesse atendimento foi realizada radiografia de tórax, evidenciando duas imagens nodulares com densidade de partes moles e limites precisos (> 8 mm) em base pulmonar esquerda. O mesmo quadro clínico se repetiu três meses depois. Em decorrência do aspecto radiológico confirmado nesse segundo episódio de AIT, a paciente foi avaliada por pneumologista, que levantou a hipótese diagnóstica de malformação arteriovenosa pulmonar, sendo encaminhada para o serviço de cirurgia vascular. Após período longo de avaliação e medicação co...

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Section: Discussionunclassified

Oclusão de fístula arteriovenosa pulmonar com plug vascular em paciente com embolia cerebral paradoxal prévia

Faria¹,

Garzon²,

Jacob³

2011

Rev. Bras. Cardiol. Invasiva

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Section: Discussionmentioning

confidence: 99%

“…4 Clinicians should suspect pulmonary arteriovenous fistula in children with cyanosis in whom initial tests do not reveal cardiac abnormalities. 4 A review of cases shows a range of clinical presentations, including severe forms in newborns and a milder, less lethal form in older patients. Numerous case reports have documented fistulas from the pulmonary artery to the left atrium in patients who present for the first time in their teens with late-onset cyanosis and few other symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…5 Cyanosis of varying degrees, clubbing, shortness of breath, heart failure and polycythemia are cardinal symptoms and signs. 4 Currently the best noninvasive diagnostic test is contrast bubble echocardiography, in which agitated saline solution is injected into a peripheral vein. The capillary alveolar filter should not allow the passage of these microbubbles through the lungs.…”

Section: Discussionmentioning

confidence: 99%

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True blue: a puzzling case of persistent cyanosis in a young child

Porepa¹,

Benson²,

Manson³

et al. 2009

Canadian Medical Association Journal

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A 2-year-old twin boy was referred to a cardiology clinic for long-standing cyanosis. He had been born to a healthy 36-year-old mother. The diamnionic, dichorionic twin pregnancy had been complicated by maternal cholestasis, which had been treated with ursodiol. Amniocentesis had been performed, and the findings were normal.The twins had been delivered by cesarean section at 34+6 weeks' gestation. Our patient's Apgar scores were 8 at 5 minutes and 9 at 10 minutes. His birth weight was 2225 g. He required tracheal intubation shortly after birth because of low oxygen saturation levels. An initial radiograph of his chest showed an increased cardiothoracic ratio, which raised suspicion of congenital heart disease. An echocardiogram appeared normal except for a restrictive patent arterial duct. The tracheal tube was removed shortly thereafter.He remained on low-flow supplemental oxygen for 4 weeks. His oxygen saturation levels were in the low 90% range, falling to the mid-80% range without oxygen. The differential diagnosis for his dependence on supplemental oxygen included patent ductus arteriosus, neonatal chronic lung disease and mild pulmonary hypertension (although this last condition was not confirmed on an echocardiogram). The boy was given nebulized budesonide therapy and weaned off oxygen. He was discharged home with no oxygen therapy. His twin sibling had an unremarkable postpartum course and had no need for oxygen therapy.Over time, the patient showed normal growth, development and energy levels. His growth consistently measured in the 5th percentile for weight and the 10th percentile for height, and matched that of his twin sister.During his second year, his parents observed a persistently blue tinge around his lips and nail beds. He showed no associated shortness of breath, loss of consciousness or distress. A general pediatrician who was following him at the time ruled out methemoglobinemia and arranged a follow-up radiograph of the boy's chest. The radiograph was reported as normal. The boy's oxygen saturation levels had not been documented since his discharge from the neonatal intensive care unit.On examination in the cardiology clinic, the boy looked well and was in no distress. His heart rate was 114 beats/min and his blood pressure 90/43 mm Hg in the left arm. His oxygen saturation level was 73% in room air. His height was in the fifth percentile at 81 cm, and he weighed 10 kg, also in the fifth percentile. He had visible cyanosis of his mucous membranes and lips (Figure 1) and clubbing of his fingers and toes (Figure 2). He had a very short grade 1/6 systolic ejection murmur that was best heard at the upper left sternal border. The rest of the findings on examination were normal.A radiograph of the chest showed increased opacity in the left hilum (Figure 3). An electrocardiogram showed normal sinus rhythm and no evidence of chamber enlargement or ischemic changes. In a hyperoxia test using 100% oxygen and

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“…There have been case reports of AVSD with intact septa, where the diagnosis was made at necropsy (2). In 2005, we validated quantitative echocardiographic measurements that helped in diagnosing of AVSD with no primum ASD: the measurements of the left ventricle inlet to outlet distance ratio and the percentage of the left AV valve guarded by the mural leaflet (3). In this report we describe four more cases of AVSD without primum ASD diagnosed using the above echocardiographic measurements.…”

Section: Introductionmentioning

confidence: 90%

Successful treatment of pulmonary arteriovenous malformation and infantile hepatic hemangioendothelioma with alpha-interferon

Özdemir¹,

Bozkurt²,

Örün³

et al. 2011

Anadolu Kardiyol Derg

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Diagnosis and therapeutics of pulmonary arteriovenous fistula in childhood. Case report and review of the literature

Cited by 9 publications

References 18 publications

Oclusão de fístula arteriovenosa pulmonar com plug vascular em paciente com embolia cerebral paradoxal prévia

Oclusão de fístula arteriovenosa pulmonar com plug vascular em paciente com embolia cerebral paradoxal prévia

True blue: a puzzling case of persistent cyanosis in a young child

Successful treatment of pulmonary arteriovenous malformation and infantile hepatic hemangioendothelioma with alpha-interferon

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