Successful occlusion of a large pulmonary arterio-venous fistula with Amplatzer septal occluder in a 16-year-old cyanotic boy

Abstract

Pulmonary arteriovenous fistulae (PAVF) are defined as the abnormal connections between pulmonary arterial and venous circulation bypassing the capillary bed [1]. PAVF might be a part of Osler-Weber-Rendu syndrome or can occur as an isolated anomaly [2]. The presentations of PAVF can range from asymptomatic abnormal shadow in the chest X-ray to the right to left shunt leading to cyanosis [3]. This shunt might result in hypoxemia manifesting with dyspnea, as well as paradoxical embolization, which can cause serious neurologic complications [3]. Case reportOur patient was a 16-year-old boy who presented with clubbing and cyanosis since five years of age. He did not have cyanosis since birth. There was neither history of recurrent lower respiratory tract, nor any history suggestive of congestive heart failure in the childhood. There was no feature of telengiectasia in the skin or mucous membrane. Clinical examination showed central cyanosis, pan-digital clubbing with SpO 2 of 84% in room

A massive pulmonary arteriovenous fistula complicated with coronary atherosclerotic heart disease treated by interventional therapy : a case report

“…For PAVF patients with feeding artery diameter < 5 mm, coil closure is recommended. For PAVF with the diameter of feeding artery ≥ 5 mm, the use of coil will increase the risk of its detachment and displacement or even ectopic embolism, and the use of occluder is more effective and safe [11]. At present, the conservative treatment of diffuse PAVF is mainly to improve the symptoms of hypoxia.…”

Transcatheter management of life-threatening pulmonary arteriovenous fistula with extracorporeal membrane oxygenation support in an infant

“…The diagnosis of extracardiac shunt can be confirmed via contrast echocardiographic evaluation using agitated saline, and the diagnosis can be made using CT angiography or conventional pulmonary angiography. 5 Pulmonary angiography is considered the golden standard in diagnosis. 1 Hereditary haemorrhagic telangiectasis (Osler-Weber-Rendu syndrome) can be part of the disease or emerge as an isolated abnormality.…”

“…In untreated patients, heart failure, chronic cyanotic complications, neurological complications due to paradoxical embolism, endocarditis, and death due to aneurysmal fistula rupture can be seen. 1,2,5 With the advancements in transcatheter devices and increased experience in this matter, fistula embolisation procedures can be successfully performed as an alternative to surgical treatment. Even large fistulae can be closed using one or multiple devices.…”

“…Even large fistulae can be closed using one or multiple devices. 5 Today, the procedure of transcatheter embolisation using coils or vascular plugs for lesions ≥3 mm is accepted as a treatment of priority. 1 In our patient, fistulae were detected under CT imaging and pulmonary angiography.…”

Device closure of fistula from lower left pulmonary artery to left atrium using a vascular plug: A case report

“…Agitated saline contrast echocardiography could provide additional information when pulmonary artery-to-left atrial fistula is suspected. A close differential diagnosis of pulmonary arteriovenous fistula must always be kept in mind[ 6 ]. Although invasive pulmonary angiography is diagnostic, it should be reserved for intervention because computed tomography angiography with three-dimensional reconstruction provides most of the information needed to decide whether a fistula can be percutaneously plugged by a device or requires surgical closure[ 7 ].…”