Case Of Pulmonary Arteriovenous Fistula Research Articles

Two Cases of Pulmonary Arteriovenous Fistula Presented with Storoke

Two Cases of Pulmonary Arteriovenous Fistula Presented with Storoke

A Case of Pulmonary Arteriovenous Fistula Presented with Cerebral Infarction

症例は58歳，女性．失語症と右上肢麻痺で当院へ救急搬送となり，精査で左中大脳動脈塞栓症と診断され，血栓回収療法を施行された．特記すべき既往歴はなかった．頭部MRIで脳主幹動脈の狭窄はなく，経食道エコー検査で卵円孔開存なども認めなかった．胸部CTで左肺下葉に肺動静脈瘻を指摘され，Rendu-Osler-Weber病を伴わない右左シャントによる，比較的稀な奇異性脳塞栓症と考えられた．治療は経皮的カテーテル塞栓術が第一選択とされることが多いが，本症例は病変が肺末梢に位置しており，流出血管も比較的太く，安全性や根治性の面から，胸腔鏡下肺部分切除術を選択した．全身状態などから手術が許容される場合には，肺末梢の単発の肺動静脈瘻に対しては，胸腔鏡下肺部分切除術は有用な治療法と考えられたため，文献的考察を加えて報告する．

A Case of Pulmonary Arteriovenous Fistula Associated With Pregnancy That Required Surgery

A Case of Pulmonary Arteriovenous Fistula Associated With Pregnancy That Required Surgery

Report from the 4(th) Vietnam Congress of Congenital and Structural Heart Disease (8-10 January 2014, Saigon, Vietnam) - "Fistulas from A to Z".

Report from the 4(th) Vietnam Congress of Congenital and Structural Heart Disease (8-10 January 2014, Saigon, Vietnam) - "Fistulas from A to Z".

Hb値3.4g/dlの高度貧血を伴った肺動静脈瘻の1例

症例は70歳，男性．50歳頃から反復する鼻出血を自覚していた．6年前の検診時の胸部X線検査で左中肺野の腫瘤影を指摘されるも放置していた．某日，呼吸困難を主訴に当院循環器科を受診した．来院時の血液検査で反復する鼻出血によるHb 3.4g/dlと高度貧血を認め，腫瘤影の増大と貧血，右心不全によると考えられる両側胸水を認め，心エコー検査にて右室圧50mmHgと高値であった．また，3D-CTにて左上葉に約6cm大の肺動静脈瘻を認めたため手術目的に当科へ転科となった．家人にも反復する鼻出血が認められ，Rendu-Osler-Weber病（以下ROW）が強く疑われ，ROWに合併した肺動静脈瘻と診断した．手術は左後側方開胸下に左上葉切除術を施行し，術前Hb 3.4g/dlであった貧血も術後退院時には11.2g/dlまで回復し，術前SaO2も93％から97％（室内気）と改善し，第7病日退院となった．

Early experience on peripheral vascular application of the vascular plugs

Transcatheter closure of various congenital and acquired vascular malformations with Amplatzer Vascular plugs I and II has been established. Here we present our experience with device closure. Between October 2006 and August 2012, nine (three males and six females) patients aged between 11 months and 62 years (mean age 19 years) underwent percutaneous device closure with AVP I and II vascular plugs for congenital and acquired arteriovenous malformation and cardiac diverticulum are presented here. One caseof coronary cameral fistula, four cases of pulmonary arteriovenous fistula, one case of large major aortopulmonary collaterals (in tetralogy of Fallot closed before intracardiac repair), one case of congenital cardiac diverticulum, one case of fistula between external carotid artery and internal jugular vein and one case of iatrogenic carotid jugular fistula were successfully closed with AVP I and II plugs. Overall in nine cases, 16 AVP I and II plugs were deployed to occlude feeding vessels and one cardiac diverticulum. The technical success rate was 100%. No major complications were observed. Amplatzer vascular plugs can be used successfully for closure of various congenital and acquired vascular malformations with good result.

Pulmonary arteriovenous fistula coexisting with secundum atrial septal defect

Pulmonary arteriovenous malformations (PAVM) consist of an abnormal connection between the pulmonary artery and vein bypassing the pulmonary capillary bed. Pulmonary arteriovenous fistulae are characterized by a right-to-left shunt of variable magnitude, and they may be accompanied by other congenital anomalies. We describe a case of pulmonary arteriovenous fistula with a secundum type atrial septal defect (ASD) in a 38-year-old woman, who underwent successful transcatheter closure of both the ASD and PAVM.

A Case of Pulmonary Arteriovenous Fistula Benefited by Transcatheter Embolotherapy.

A Case of Pulmonary Arteriovenous Fistula Benefited by Transcatheter Embolotherapy.

３Ｄ‐ＣＴで評価し胸腔鏡下肺部分切除術を施行した肺動静脈瘻の２例

3D-CTで評価し胸腔鏡下肺部分切除術を施行した肺動静脈瘻の2例について報告する．1例目は79歳女性．2例目は59歳女性．両症例とも肺の異常陰影を指摘され当院を紹介され受診した．身体所見に特記事項は認めなかった．Rendu-Osler-Weber病の症状，家族歴は認めなかった．3D-CTにて単一の流入・流出血管および肺動静脈瘻が同定された．手術は胸腔鏡下肺部分切除術を行った．組織学的検索の結果，肺動静脈瘻であることが確認された．術後経過は良好であった．3D-CTは病変の評価に有用であることが確認された．胸腔鏡下手術は，外科的切除の確実性という観点から予後良好である，開胸に比べ低侵襲であるという利点がある．単一の流出入血管を伴い，胸膜直下の末梢肺野に発生した直径2cm以下の肺動静脈瘻は胸腔鏡下手術の良い適応と考えられた．

3次元CTと肺血流シンチグラフィーで評価し手術を行った肺動静脈瘻の2例

肺動静脈瘻の2手術例を報告する.症例1,57歳,男性.脳梗塞にて他院入院時,左肺野異常陰影を指摘された.精査の結果,肺動静脈瘻と診断されて手術目的に当科紹介となった.チアノーゼ,低酸素血症,多血症を認めた.症例2,33歳,男性.無症状であったが,検診で左肺野の腫瘤陰影と肺血管の拡張を指摘された.2症例とも3次元CTで,肺動静脈瘻の描出と流入・流出肺血管の同定が可能であった.さらに,肺血流シンチグラフィーで肺外臓器への核種分布が認められ,右→左シャントの存在が明らかであった.いずれも手術を行い経過は良好であった.肺動静脈瘻に対して手術治療を選択する場合,3次元CTによる解剖学的評価と肺血流シンチグラフィーによる機能評価は非侵襲的で有用な検査であると考える.

Rare case of pulmonary arteriovenous fistula simulating residual defect after transcatheter closure of patent foramen ovale for recurrent paradoxical embolism

We report on a patient suffering from recurrent cerebrovascular events despite previous transcatheter closure of persistent foramen ovale (PFO) with a Helex occluder. There was evidence of persistent left-to-right atrial shunt shown by transesophageal contrast echocardiography and the patient was admitted to our institution for interventional closure of the supposed residual defect. However, the PFO was completely closed by the device and left pulmonary artery injections showed a pulmonary arteriovenous fistula in the left lower lobe. This rare malformation may well explain the recurrent paradoxical embolism. Transcatheter fistula closure with coils was performed successfully. This case underlines that the existence of an isolated pulmonary arteriovenous fistula as a right-to-left shunt in patients with cryptogenic stroke should not be overlooked, even if a PFO is present and pulmonary arteriovenous fistula is not suggested by the initial physical findings or chest X-ray.

脳膿ようを合併した肺動静脈ろうの一手術例

今回我々は脳膿瘍を合併した肺動静脈瘻の一手術例を経験したので報告する.症例は38歳男性.健診で胸部異常を指摘されていた.発熱に続く頭痛・意識混濁を主訴に近医受診し, 精査の結果脳膿瘍と診断され治療を受けた.脳膿瘍の原因が肺動静脈痩と診断されたため根治目的で当科紹介された.入院時, 体動時呼吸困難および低酸素血症を認めた.造影剤アレルギーがみられ, 経カテーテルによる治療は適応外と判断し, 肺区域切除術を施行した.術後経過は良好で術後14日に退院した.術後, 呼吸困難および低酸素血症の改善が見られた.当症例は外科的切除が有効な治療方法であったと考えられた.

A Case of Pulmonary Arteriovenous Fistula with Family History

Pulmonary arteriovenous fistula is a congenital vascular malformation in lung resulting from abnormal capillary development and the exact etiology is not well known but it may occur with or without hereditary hemorrhagic telangiectasia. Hereditary hemorrhagic telangiectasia (HHT) or Rendu-osler-Weber disease is an autosomal dominant vascular disorder which associates epistaxis, mucocutaneous and visceral telangicetases, and recurrent hemorrhage with chronic anemia and visceral shuntings. Recently we experienced a case of the pulmonary arteriovenous fistula in a 23 year-old woman with a family history of this disease, which was confirmed by pulmonary angiography.

A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

The patient was a 30-year-old woman in her 38th week of pregnancy, who was 156cm tall and weighed 58kg. She had shown cyanosis since 6 years of age. At the age of 8, dyspnea on exertion developed, and cardiac disease was suspected. At the age of 14, she was examined by cardiac catheterization, but no abnormalities were found. No special therapy was performed. In the present pregnancy period, polycythemia [red blood cell count (RBC) 533 • 104.~1-1, hemoglobin concentration (Hb) 17.1g.d1-1, and hematocrit (Ht) 51.6%] were observed. Although she underwent further examinations such as computed tomography (CT), magnetic resonance imaging (MRI), radioisotope (RI)angiography, and chest X-ray, no abnormal findings other than hypoxemia and right aortic arch were ob-

A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

A case of pulmonary arteriovenous fistula in which venous air embolism during cesarean section may have caused postoperative subendocardial infarction

A CASE OF PULMONARY ARTERIOVENOUS FISTULA WITH OSLER-WEBER-RENDU SYNDROME-A REVIEW OF REPORTED CASES IN JAPAN-

A case of pulmonary arteriovenous fistula with Osler-Weber-Rendu syndrome is described here. A 34-year-old woman was referred to the hospital because of an abnormal shadow in the lower area of the right lung. Chest tomography and CT revealed a pulmonary arteriovenous fistula located in the right middle lobe. Gastroscopy disclosed multiple mucosal telangiectases. In addition, her eldest son has an episode of rupture of spinal arteriovenous malformation. The patient was diagnosed as Osler-Weber-Rendu syndrome. Right middle lobectomy was performed. The postoperative course was uneventful. Forty-seven cases of pulmonary arteriovenous fistula with Osler-Weber-Rendu syndrome has been reported in Japan. Twenty-eight of 47 patients (60%) were females. The mean age was 34 years old and 29 patients (62%) were under 40 years old. Twenty-six patients (55%) had multiple pulmonary arteriovenous fistulas. Polycythemia was seen in 15 patients (32%) but on the contrary anemia was seen in some patients because of recurrent hemorrhage. Pulmonary arteriovenous fistula may involve brain complications such as abscess and embolism, so surgical resection should be considered, if possible.

A case of pulmonary arteriovenous fistula complicated with primary pulmonary hypertension and patent foramen ovale

A case of pulmonary arteriovenous fistula complicated with primary pulmonary hypertension and patent foramen ovale

A case of pulmonary arteriovenous fistula diagnosed with contrast echocardiography.

A case of pulmonary arteriovenous fistula diagnosed with contrast echocardiography.

Local excision of pulmonary arteriovenous fistulae including the feeding artery and draining vein.

Two cases of pulmonary arteriovenous fistula were treated by local anatomical dissection and excision. This technique is preferable to pulmonary resection when the fistula is localised and superficially situated. The feeding vessels must be included in the resection to avoid possible recurrence. The history of the surgical removal of arteriovenous fistulae is discussed, and the reasons for preferring local excision are given.

Pulmonary Arteriovenous Fistulas with Pulmonary Hypertension

Two cases of pulmonary arteriovenous fistulas associated with pulmonary hypertension occurring in young multiparous women are described. Both cases suggest the development of pulmonary arteriovenous fistulas subsequent to and as a consequence of the onset of pulmonary hypertension. Etiologic factors resulting in the development of the pulmonary hypertension in these patients, including the possible role of estrogens, are considered. The possible causal relationship of the pulmonary hypertension to the development of the pulmonary arteriovenous fistulas is discussed, and the importance of detecting the presence of pulmonary hypertension is stressed, since resection of the arteriovenous fistulas would be contraindicated in this situation.