Systemic artery—pulmonary vein fistulas: Congenital and acquired left to left shunt

Abstract

Fistulas from systemic arteries to the pulmonary vein may be congenital or acquired. Hemodynamically significant left to left shunts are associated with a continuous murmur, bounding peripheral pulses and left ventricular enlargement. Clinically they may be indistinguishable from left to right shunts into the pulmonary artery. Atypical location of the continuous murmur, lack of evidence of increased pulmonary flow and evidence of localized lesions in pulmonary parenchyma should lead to a suspicion that a left to left shunt is present. At cardiac catheterization left to left shunts are not associated with increased oxygen saturation in the pulmonary artery and may be clearly outlined with the use of arteriography. Two cases are presented, 1 representing a congenital and the other an acquired left to left shunt.