Iatrogenic left pulmonary artery to left atrium fistula

Trans‐catheter balloon angioplasty is a well‐established treatment modality for pulmonary artery (PA) stenosis in children with congenital heart disease. We report a case of an unusual complication where a fistula developed between the left PA and the left atrium during balloon angioplasty in a patient with history of tetralogy of Fallot. This was successfully treated with placement of a covered stent. © 2014 Wiley Periodicals, Inc.     

Acquired internal mammary artery to pulmonary artery fistula following bypass surgery

We report two patients with acquired fistulas between the internal mammary and pulmonary arteries after coronary bypass surgery. This is a rare complication of bypass surgery and may be a cause of recurrent angina postoperatively due to coronary artery steal. A table of all the cases reported in the literature is compiled.     

Coronary arterio-venous fistula from left main stem to pulmonary artery

We describe a patient with coronary arteriovenous fistula discovered during routine coronary angiography for evaluation of ischaemic heart disease. Angiography revealed a rare anomaly connecting left main stem to pulmonary artery.     

Coronary fistula from left main stem to main pulmonary artery

We describe a patient with a rare coronary arteriovenous fistula connecting the left main stem to the main pulmonary artery. This rare case was discovered during routine coronary angiography for the evaluation of the patient s coronary heart disease.     

Ectopic right coronary artery to pulmonary artery fistula masquerading as patent arterial duct

A patient is described in whom communication between an ectopic right coronary artery and the main pulmonary artery presented with clinical features of a patent arterial duct. Full clinical data documented by Doppler echocardiography, cardiac catheterisation and intra-operative findings are described.     

左右冠状动脉肺动脉瘘一例

患者女性,39岁,主因"发现心脏杂音38年,发作性胸闷、胸痛3年,加重1个月"收入院.患者38年前查体时发现心脏杂音,诊断为"心脏病",未予诊治.     

Descending thoracic aorta to left pulmonary artery fistula after stent implantation for acquired left pulmonary artery stenosis

This is a case report of a Fontan patient with previous Potts anastomosis who underwent stent implantation for left pulmonary artery stenosis. At follow-up the patient developed a fistula between the descending thoracic aorta and the left pulmonary artery at the site of the stent. This represents a late complication of stent placement.     

Therapeutic embolization of the pulmonary artery in pulmonary arteriovenous fistula

A 35 year old white man was admitted in January 1976 for further treatment of pulmonary A-V fistula. In 1975, he had dyspnea, cyanosis and clubbing; pulmonary angiogram showed a fistula in the lower lobe of the left lung and one in the upper lobe of the right lung; the arterial oxygen tension (PaO₂) was 54 mm Hg and the calculated intrapulmonary shunt was 25 per cent of the cardiac output; a lobectomy of the left lung was performed. On this admission, dyspnea, cyanosis and clubbing were still present: the PaO₂ was 67 mm Hg and the intrapulmonary shunt 14 per cent. Since it was possible to show angiographically that, by balloon inflation during Swan-Ganz catheterization of the upper lobe of the right lung, the single pulmonary A-V fistula was completely obliterated with correction of the intrapulmonary shunt, mechanical occlusion was attempted as an alternative to further surgery. Through a No. 7 French catheter inserted via a femoral vein into the pulmonary artery of the upper lobe of the right lung and with the help of repeated selective angiography, six mechanical occluding devices (each consisting of a 5 cm segment of steel guidewire with 3 cm wool tails) were placed into the vessels feeding the fistula. Twenty minutes after placement of the last two coils, the fistula was almost totally occluded on angiogram; the PaO₂ was 79 mm Hg and the intrapulmonary shunt was 7 per cent; over the following three weeks, without further manipulation, these returned to normal (91 mm Hg and 4 per cent, respectively). No complications have been noted. The patient has been symptom free during 12 months of close follow-up; results of oxygen studies have remained normal; on chest film the six coils have not changed position. The procedure described here, to our knowledge performed for the first time for correction of pulmonary A-V fistula, should be considered in preference to surgical resection in selected patients with this condition.     

Transcatheter closure of large pulmonary arteriovenous fistula including pulmonary artery to left atrial fistula with Amplatzer septal occluder.

OBJECTIVES: We sought to evaluate the safety and efficacy of Amplatzer septal occluder (ASO) to close very large pulmonary arteriovenous fistula (PAVF). BACKGROUND: Transcatheter coil embolization, the standard treatment for PAVF, has potential complications particularly in patients with very large fistulas. Several recently available devices have been tried effectively, however, they too have limitations. METHODS: During 2004, three patients (aged 17-56 years), diagnosed with large PAVF including one with pulmonary artery (PA) to left atrial (LA) fistula, had interventional closure prospectively using ASO. Following hemodynamic evaluation and angiographic localization of PAVF, the feeding artery (FA) was selectively cannulated with Amplatzer delivery sheath. ASO, with the right atrial (RA) disc diameter equal to or up to 4 mm larger than the maximum diameter of FA, was delivered through it in such a way that the left atrial disc assumed an oblong shape and the right atrial disc retained its designed flat configuration for better anchorage and thrombogenicity. RESULTS: All patients had very large PAVF fed by a single FA (size 12-24 mm), which was closed completely, without complications, using ASO (size 7-16 mm; RA disc diameter 15-26 mm). Their arterial saturation rose from mean 72.3% to 97.3%. Follow up (1.5-3 years) showed disappearance of the radiological shadows and stable arterial saturations (mean 97.7%). CONCLUSIONS: We conclude that, using the new criteria for device size selection and modified technique of implantation, very large PAVFs including PA to LA fistula can be closed safely, effectively and nonsurgically with ASO.     

Coil embolization of a coronary artery to pulmonary artery fistula from an antegrade approach

Transcatheter embolization of coronary artery fistulae has become the therapy of choice for this uncommon lesion. We report a case in which transcatheter embolization was performed in a nine-year-old boy with a large fistula originating from the proximal portion of the left anterior descending artery and communicating with the pulmonary artery and the right coronary artery. The fistula was occluded ‘antegrade’ by cannulating the connection with the pulmonary artery to deliver occluding coils. Cathet. Cardiovasc. Diagn. 42:68–69, 1997. © 1997 Wiley-Liss, Inc.