Congenital Systemic Arteriovenous Fistula between the Descending Aorta, Azygos Vein, and Superior Vena Cava

Soler, Pilar; Mehta, Ashok V.; García, Otto L.; Kaiser, Gerard A.; Tamer, Dolores

doi:10.1378/chest.80.5.647

Cited by 40 publications

(27 citation statements)

References 3 publications

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“…Initial symptoms and signs may include congestive heart failure or continuous or innocent murmurs. Several case reports of an arteriovenous fistula simulating patent ductus arteriosus have been published (6). The present patient also had a patent ductus arteriosus, which was the main cause of late diagnosis.…”

Section: Discussionmentioning

confidence: 56%

Percutaneous embolization of carotico-azygous fistula with amplatzer vascular plug-i

Öztürk

Ödemiş²,

Güzeltaş³

et al. 2011

Diagn Interv Radiol

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431C arotico-azygous fistula is an extremely rare form of arteriovenous fistula, resulting from an abnormal communication between the carotid artery and azygous vein (1-4). As a result of continuous murmur, which is a typical physical finding of these vascular malformations, a caroticoazygous fistula could be confused with patent ductus arteriosus. Transcatheter coil embolization of these fistulas has been reported previously (5).Here, we describe a five-year-old boy with caroticoazygous fistula, who also had patent ductus arteriosus, the main cause of misdiagnosis, and successful transcatheter embolization with the Amplatzer ® Vascular Plug 1 (AVP 1). Case reportA five-year-old boy was referred to our clinic with cardiac murmur. He had no history of any complaint. During physical examination, a continuous murmur was heard in the left chest area. Electrocardiogram and telecardiography were normal. Color and continuous wave Doppler echocardiography showed patent ductus arteriosus with dilated left atrium and left ventricle. Left atrium-to-aortic root diameter ratio was 1.7. He underwent cardiac catheterization and descending aorta angiography, focusing only on possible patent ductus arteriosus arising from the aorta. Patent ductus arteriosus was detected by angiography. The narrowest diameter of patent ductus arteriosus was measured as 2.3 mm. A detachable coil, 5 mm in diameter and having five loops (William Cook Europe, Bjaeverskov, Denmark), was used for occlusion of patent ductus arteriosus. No residual shunt was observed in control angiography (Fig. 1). During examination on the next day, a continuous murmur was still heard in the same area, but no residual shunt was detected by echocardiography. A chest X-ray confirmed that the coil had not migrated. We then highly suspected an arteriovenous fistula but it was not revealed by echocardiography. Therefore, other reasons for the continuous murmur were investigated. Initially, cranial computed tomography with contrast and abdominal Doppler ultrasound were performed to reveal a fistula in those areas, but the results were normal. We then decided to perform further cardiac catheterization. During the second cardiac catheterization procedure, aortic angiography detected a fistula tract between the carotid artery and azygous vein (Fig. 2).Aortic and subsequent selective angiography in anteroposterior and lateral views showed multiple branches of the vertebral arteries linking the fistula tract. It had a tortuous course, and the narrowest part measured 3.4 mm (Fig. 2). The calculated pulmonary to systemic blood flow ratio was 1.7.Lateral selective descending angiography was performed to delineate the fistula tract (Fig. 2a). The fistula tract had several connections to ABSTRACT We present the case of a five-year-old boy with a caroticoazygous fistula, which is an extremely rare congenital vascular malformation. The patient also had patent ductus arteriosus, a common cause of continuous murmur. The murmur continued despite successful coil embolization of the ductus. ...

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Section: Discussionmentioning

confidence: 56%

Percutaneous embolization of carotico-azygous fistula with amplatzer vascular plug-i

Öztürk

Ödemiş²,

Güzeltaş³

et al. 2011

Diagn Interv Radiol

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“…6 Soler et al reported that an AV fistula originating from the descending aorta and draining into the azygos vein is a very rare condition. 6 They attributed this malformation to abnormal connections between embryologic arterial and venous channels. The signs and symptoms associated with the presence of an AV fistula depend largely on the size of the fistula and the degree of resulting left-to-right shunting.…”

Section: Discussionmentioning

confidence: 99%

Case report. Multiple Mediastinal Arteriovenous Fistulas in a Patient with Myocardial Ischemia Symptoms and Tachy-Brady Arrhythmias

Kovács

Condrea²,

Rodean³

et al. 2017

Journal of Cardiovascular Emergencies

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Arteriovenous fistulas are abnormal vascular communications between the arterial and venous system and may lead to the development of arteriovenous shunts. These malformations are extremely rare, and their diagnosis can be difficult due to the lack of symptoms or the absence of hemodynamic consequences. In many cases, arteriovenous fistulas are discovered by chance. In this brief report, we present the case of a 31-year-old male with symptoms suggestive of angina pectoris, tachycardia-bradycardia syndrome and multiple episodes of syncope. Multi-slice computed tomography revealed the presence of multiple mediastinal fistulas connecting the aorta, superior vena cava, pulmonary veins and azygos system.

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“…Sonography, magnetic resonance imaging (MRI) and DSA represent the cornerstone for morphological characterization of AVMs and facilitate their differentiation from other vascular anomalies [5]. A case of arteriovenous fistula arising from the descending aorta and draining into superior vena cava and the azygos vein was described in a 14-month-old girl [6]. In another case report, a retroperitoneal undifferentiated sarcoma adjacent to the aortic bifurcation, iliac vessels and IVC was diagnosed by DSA in a 3-month-old infant [7].…”

Section: Retroperitoneal Arteriovenous Malformationmentioning

confidence: 99%

Retroperitoneal Arteriovenous Malformation: A Rare Cause of Pulmonary Hypertension in a Premature Infant

et al. 2015

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Retroperitoneal arteriovenous malformations (AVMs) are rare lesions consisting of dysplastic vessels, which may produce diverse clinical features. We report a case of premature neonate born on the 29th week of gestation, who presented with heart failure, generalized edema, respiratory dyspnea and metabolic acidosis. Digital subtraction angiography revealed a large AVM located adjacent to the aorta and the inferior vena cava. Lumbar arteries supplying the AVM were occluded by coils. The AVM was partially embolized using N-butyl cyanoacrylate. Despite apparently successful embolization procedure, heart failure and respiratory distress progressed. The newborn died on her fourth day of life. We report the first case describing AVM embolization in a very low birth weight preterm infant.

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Congenital Systemic Arteriovenous Fistula between the Descending Aorta, Azygos Vein, and Superior Vena Cava

Cited by 40 publications

References 3 publications

Percutaneous embolization of carotico-azygous fistula with amplatzer vascular plug-i

Percutaneous embolization of carotico-azygous fistula with amplatzer vascular plug-i

Case report. Multiple Mediastinal Arteriovenous Fistulas in a Patient with Myocardial Ischemia Symptoms and Tachy-Brady Arrhythmias

Retroperitoneal Arteriovenous Malformation: A Rare Cause of Pulmonary Hypertension in a Premature Infant

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