A Rare Congenital Pulmonary Arteriovenous Fistula Presenting With Recurrent Headache and Dizziness
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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00309. Epub November 27, 2024.
A 39-year-old woman presented with a recurrent headache and dizziness for 6 months. Physical examination and laboratory tests were unremarkable, and the electrocardiogram indicated sinus rhythm. Transthoracic echocardiography (TTE) showed normal heart morphology, structure, function, and hemodynamics. TTE with a microbubble test showed a grade 3 right-to-left shunt (RLS) after 6 cardiac cycles (Figure A, Video 1). Pulmonary arteriovenous fistula (PAVF) was suspected. Computed tomography pulmonary angiography (CTPA) showed a small right inferior pulmonary arteriovenous fistula (PAVF) (Figure B, C). Pulmonary angiography detected a 4-mm PAVF flowing into the right inferior pulmonary vein (Figure D, Video 2). This PAVF was successfully embolized by a SQFDQ-II Muscular VSD Occluder and its delivery system (Shanghai Shape Memory Alloy Co., Ltd.); the thickness of the occluder waist was 8 mm. After this procedure, selective pulmonary arteriography showed no residual shunt (Video 3). The postoperative course was uneventful, and the patient was discharged after 3 days. At the 6-month follow-up, the patient's symptoms had disappeared completely.
PAVF is a rare congenital vascular malformation that primarily manifests as dyspnea, migraine, ischemic stroke, hemoptysis, and nervous system complications.1 It may cause life-threatening complications, including stroke, hypoxemia, pulmonary hemorrhage, brain abscesses, and paradoxical emboli, so prompt diagnosis and treatment are crucial. Transthoracic contrast echocardiography has been recommended for screening PAVF.2 CTPA and pulmonary angiography are the recommended gold standard for detecting a PAVF.3 The transcatheter embolization of a PAVF is essential to prevent serious complications and improve the prognosis of the patient.
Affiliations and Disclosures
Leizhi Ku, MD1, Mei Wu, MD2; Juan Xia, MD2; Yafeng He, MD2; Xiaojing Ma, PhD2
From the Departments of 1Radiology and 2Echocardiography, Wuhan Asia Heart Hospital Affiliated Wuhan University of Science and Technology, Wuhan, China.
Dr Ku and Dr Wu contributed equally to the article.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Funding: This work is funded by the 2021 General Project Health and Family Planning Commission of Wuhan municipality scientific research project (WX21D46); Wuhan Clinical Medical Research Center for Cardiovascular Imaging (CMRC202307).
Consent statement: The authors confirm that informed consent was obtained from the patient for the procedures described in this manuscript.
Address for correspondence: Xiaojing Ma, PhD, Department of Echocardiography, Wuhan Asia Heart Hospital Affiliated Wuhan University of Science and Technology, Wuhan 430022, P.R. China. Email: klz1534292102@163.com
References
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2. Hessels J, Kroon S, Vorselaars VVM, Boerman S, Mager JJ, Post MC. Evolution of pulmonary arteriovenous malformations: the role of contrast echocardiography. Chest. 2023;163(3):669-677. doi:10.1016/j.chest.2022.11.005
3. Zhan J, Dong C, Li M, et al. Cryptogenic stroke caused by pulmonary arterial venous malformation with massive right-to-left shunt: a case report. Neurol Ther. 2021;10(2):1135-1142. doi:10.1007/s40120-021-00275-y
