Concomitant pulmonary and cerebral arteriovenous fistulae

The previously unreported occurrence of concomitant pulmonary and cerebral arteriovenous fistulae was found in an individual with severe neurologic complications. Both polycythemia and paradoxical embolization were implicated in the genesis of the cerebral symptoms while the cerebral fistulae were asymptomatic. An improved method of therapeutic embolization was used to treat the pulmonary lesions, avoiding surgical resection.     

Multiple coronary arteriovenous fistulae.

A case with multiple congenital coronary arteriovenous fistulae is reported. The right coronary artery was communicating with the right ventricle. The left coronary artery was entering directly into the pulmonary trunk and two terminal branches of the anterior descending into the left ventricle. The direct communication of the left coronary artery without interposition of an accessory artery or a circoid plexus is met for the first time.     

Fatal soft-tissue infection complicating pulmonary arteriovenous fistulae

A patient with pulmonary arteriovenous (AV) fistulae presented with an ultimately fatal anaerobic soft tissue infection. This represents the first report of such a complication, but the association of intracerebral anaerobic abscess with pulmonary AV fistulae suggests the possibility of a common pathophysiologic mechanism.     

Congenital pericardial arteriovenous fistula

A young man with a continuous murmur was shown by means of aortography and arteriography of the internal mammary artery to have an arteriovenous fistula on the pericardium which caused a systemic-pulmonary shunt. The fistula was operated on and closed.     

Congenital coronary arteriovenous fistula

Three verified cases of congenital coronary arteriovenous fistula have been described, bringing the total reported cases to forty-six. The combination of a machinery murmur in an unusual location, catheterization evidence of a left to right shunt, and opacification of a dilated coronary artery by angiography confirms the clinical diagnosis.

Surgical correction has proved to be safe and effective. The number of surgical cures (including two cases reported herein) now totals fifteen cases with one death due to surgery.     

Long-term safety and feasibility of arteriovenous fistulae as vascular accesses in children with haemophilia: a prospective study

Infectious and thrombotic complications limit the long-term use of subcutaneous ports as venous accesses for children with haemophilia. This study has evaluated for the first time the safety and feasibility of internal arteriovenous fistulae (AVF) as alternative accesses. During the 3-year study period, 27 severe haemophiliacs, 14 with factor VIII inhibitors (52%), underwent the creation of 31 proximal AVF in the forearm. Mild forearm haematomas were observed after five procedures (16%) in five patients who had or developed inhibitors after surgery. Inadequate AVF maturation was observed after five of 31 procedures (16%) in four children. AVF were first accessed after a median of 42 d and regularly used at home by 26 patients (96%) for a median follow-up period of 29 months. Thrombosis of a venous branch occurred in one AVF (3%) after 9 months of uncomplicated use in a child with inhibitor who spontaneously recovered from the symptoms and still used AVF for nine additional months. Mild symptoms, referable to distal ischaemia, were transiently reported by two children (7%) who needed no remedial intervention. This study demonstrates that the use of AVF in haemophiliacs enabled long-term treatment at home in all patients but one.     

Starfish-assisted off-pump obliteration of massive coronary arteriovenous fistulae

Coronary arteriovenous fistula is a rare congenital heart disease. A 71-year-old woman suffered from heart failure due to massive coronary arteriovenous fistulae from the right coronary artery and left circumflex artery to the coronary sinus. Using the off-pump technique, we successfully performed Starfish-assisted obliteration of the fistulae. Intraoperative transesophageal echocardiography was used to confirm the complete elimination of the abnormal shunt flow.     

Congenital coronary-left ventricular fistulae. Review of the literature

Congenital communications of fistulae between coronary arteries of aortic origin and the left ventricle present two types of anatomo-coronarographic appearance, in accordance with embryological theories: single fistulae and multiple or micro-fistulae. These fistulae are marked by the absence of a continuous murmur and they can be distinguished from each other by their clinical expression: either a picture of aortic incompetence or signs of coronary insufficiency: these are the conclusions from a review of 62 cases in the literature.