What is it about?
Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly. Left pulmonary artery-to-left atrial fistula is rare. We report the case of a 40-year-old male who presented with effort intolerance, central cyanosis, and recurrent seizures. He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course. Catheter-based closure was performed using a vascular plug.
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Why is it important?
Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula. Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred. The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath, necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.
Perspectives
Left pulmonary artery-to-left atrial fistula is relatively rare compared to right pulmonary artery-to-left atrial fistula, as previously reported[1]. The first case of pulmonary artery-to-left atrial fistula was reported in 1989 as an unusual cause of cyanosis in a newborn[2]. A significant right-to-left shunt is clinically marked by effort intolerance, cyanosis, and polycythemia, as well as sometimes bleeding issues related to associated hemangioma[3,4]. Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous malformation. There is significant clinical suspicion of this condition when there is cyanosis without any obvious murmur in the precordium. Echocardiography shows a significant increase in pulmonary venous return to the left atrium, which is an additional clue and can be confirmed by cardiac catheterization or contrast-enhanced computed tomography. This case reports the relevant issues we encountered during the percutaneous device closure of a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in its course in an adult.
Dr Ramachandra Barik
All India Institute of Medical Sciences
Read the Original
This page is a summary of: Device closure of fistula from lower left pulmonary artery to left atrium using a vascular plug: A case report, World Journal of Cardiology, April 2021, Baishideng Publishing Group Co., Limited (formerly WJG Press),
DOI: 10.4330/wjc.v13.i4.111.
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