Systemic Artery to Pulmonary Vein Fistula After Right Upper Lobectomy Demonstrated by 4-Dimensional Flow Magnetic Resonance Imaging (original) (raw)
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Aorta–to–Pulmonary Vein Fistula in an Asymptomatic 25-Year-Old Man
A 25-year-old man with no significant medical history was found to have a continuous murmur along the left sternal border on routine physical examination performed in preparation for running a marathon. Echocardiography showed a dilated left ventricle with normal function and continuous high-velocity flow in an aberrant vessel in close vicinity to the abdominal aorta (Movie I in the online-only Data Supplement). Chest x-ray (posterior-anterior and lateral projections , Figure 1) disclosed conglomeration of tubular densities in a scimitar pattern in the right lower lobe suggestive of anomalous pulmonary venous return of right lower lobe (scim-itar syndrome; anomalous drainage of right lung pulmonary veins into the inferior vena cava). Cardiac magnetic resonance imaging (MRI) not only demonstrated normal drainage of all 4 pulmonary veins into the left atrium but also revealed an aberrant vessel (Movie II in the online-only Data Supplement) extending between the abdominal aorta and the right inferior pulmonary vein with an elevated systemic-to-pulmonary flow ratio of 1.8, consistent with a large left-to-left shunt. Cardiac computed tomography (CT) confirmed the presence of a large fistulous connection between the abdominal aorta and the right inferior pulmonary vein (Figure 2 and Movie III in the online-only Data Supplement) located in the right lower lobe (Figure 3A). Although there was no distinct lung parenchyma changes on CT and MRI, the presence of con-glomerated fistula vessels in the right lower lung lobe limited the ability to exclude associated intralobar lung sequestration. Therefore, cardiac catheterization (Movie IV in the online-only Data Supplement) was subsequently performed before consideration of percutaneous closure of the fistula. However, this treatment option was abandoned because of concerns that perfusion of the right lower lung lobe was fistula dependent. The patient was then referred for open surgery to determine whether the fistula could be closed safely, which was done by temporarily occluding the fistula with a snare and observing the color of the segment of the lung after 5 minutes of
Surgery today, 2006
which had begun to bleed profusely about 3 h before admission. He had undergone a left upper lobectomy for a lung damaged by a tuberculous parenchymal infection 12 years earlier, at which time silk suture ligation of pulmonary vessels was used. About 2 years later, he underwent a partial thoracoplasty with complete removal of the 6th to 10th ribs and an intrathoracic omental flap transfer for persistent postresectional left pleural empyema. His blood loss was estimated to be almost 750 ml. Chest radiograph, computed tomography (CT) scanning, and magnetic resonance angiography (Fig. 1) did not show the cause of the hemorrhage, so we performed an emergency left lateral thoracotomy. Because of the altered regional anatomy, we encountered unique technical problems. The changes in the left hemithorax and the scoliotic vertebral column had caused the descending aorta to follow a subcutaneous course underneath the bleeding point. This finding along with the high oxygen content of the fistulous blood led us to conclude that the descending aorta was the feeding vessel. Thus, we decided to directly suture the aortic wall or use a pericardial patch repair, without any need for cross-clamping the descending aorta or extracorporeal circulatory support. Thoracotomy was started from the anterior third of the 4th intercostal space and continued posterolaterally, using cautious dissection of the intrapleural elements. We encountered dense adhesions between the left lung remnants, the aorta, and the parietal pleura. Meticulous dissection of the hilar elements revealed the superior pulmonary vein stump to be the fistulous internal ending. We performed an intrapericardial completion pneumonectomy with superior pulmonary vein reamputation at the left atrial wall. The pericardial defect was reconstructed with Gore-Tex mesh. The patient was transferred to the surgical intensive care unit (SICU). His postoperative course was complicated by episodes of supraventricular arrhythmias and
Aberrant systemic artery-pulmonary venous fistula: diagnosis with Doppler imaging
International Journal of Cardiology, 1992
quently estimated and found to be high. On the third postoperative day chemotherapy with adriamycin and methotrexate was instituted. On the sixth postoperative day the patient started to become drowsy. CT scan of the head showed large deposits in the frontoparietal region. The patient, however, continued to deteriorate and died on the twelfth postoperative day. Autopsy could not be performed.
Surgical Correction of a Fistula Between Left Pulmonary Artery and Innominate Vein
A 48-year-old woman with chronic dyspnea complaints was referred to the thoracic surgery clinic for a surgical lung biopsy to make a definitive diagnosis of interstitial lung disease. Thoracic computed tomography imaging revealed a vascular structure located anterior to the aorta, between the left innominate vein and the pulmonary artery. Magnetic resonance angiography showed the abnormal vessel connection in detail. Pulmonary perfusion scintigraphy showed decreased perfusion of the left upper lobe and the superior lingular segment. A fistulectomy was performed through a mini thoracotomy. The patient no longer had any dyspnea symptoms after the operation.
Pulmonary artery-bronchial fistula. A new complication of bedside pulmonary arteriography
Chest, 1980
arteriography. complication of bedside pulmonary Pulmonary artery-bronchial fistula. A new http://chestjournal.chestpubs.org/content/78/2/355a.citation can be found online on the World Wide Web at: The online version of this article, along with updated information and services ) ISSN:0012-3692 http://chestjournal.chestpubs.org/site/misc/reprints.xhtml
BMC Pulmonary Medicine
Background: Systemic artery to pulmonary artery fistulas (SA-PAFs), are extremely rare in people without congenital heart disease. In this group of patients pulmonary arterial hypertension was reported in the single case. Then, we describe a case of multiple SA-PAFs, which were the cause of severe nonreversible arterial pulmonary hypertension in a patient who had a right-sided pneumothorax 35 years earlier. Case presentation: 52-year-old male Caucasian patient with echocardiographically confirmed pulmonary hypertension (PH) was admitted to cardiology department due to exertional dyspnea and signs of right ventricle failure. Routine screening for causes of secondary PH was negative. Right heart catheterization (RHC) confirmed a high degree arterial PH [mean pulmonary artery pressure (mPAP); 50,6 mmHg, pulmonary wedge pressure (PWP); 11,3 mmHg, pulmonary vascular resistance (PVR); 11,9 Wood's units (WU)] irreversible in the test with inhaled nitric oxide. Oxygen saturation (SaO 2) of blood samples obtained during the first RHC ranged from 69.3 to 73.2%. Idiopathic pulmonary arterial hypertension was diagnosed. Treatment with inhaled iloprost and sildenafil was initiated. Control RHC, performed 5 months later showed values of mPAP (59,7 mmHg) and PVR (13,4 WU) higher in comparison to the initial measurement, SaO 2 of blood obtained during RHC from upper lobe artery of the right lung was elevated and amounted 89.7%. Then, pulmonary arteriography was performed. Lack of contrast in the right upper lobe artery with the evidence of retrograde blood flow visible as a negative contrast in the right pulmonary artery was found. Afterwards, right subclavian artery arteriography detected a huge vascular malformation communicating with right upper lobe artery. Following computed tomography angiogram (angio-CT) additionally revealed the enlargement of bronchial arteries originated fistulas to pulmonary artery of right upper lobe. In spite of intensive pharmacological treatment, including the therapy of pulmonary hypertension and percutaneous embolisation of the fistulas, the patient's condition continued to deteriorate further. He died three months after embolisation due to severe heart failure complicated by pneumonia.
Journal of Perioperative Echocardiography, 2014
Direct right pulmonary artery-left atrial communications are rare causes of congenital cyanotic heart disease. Bypassing of the pulmonary circulation and the filtering function of the lung predisposes these patients to high risk of stroke or cerebral embolism. Contrast echocardiography using transesophageal echocardiography helps in detection and/or confirmation of diagnosis of these extracardiac shunts as two-dimensional echocardiography of the heart is essentially normal in such patients. Additionally, it can help in the assessment of adequacy of surgical repair in the postoperative period.