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Pamela Moceri, Yann Diascorn, Jean-Philippe Berthet, Emile Ferrari, Giant pulmonary arteriovenous malformation revealed by recurrent pregnancy loss, European Heart Journal, Volume 39, Issue 45, 01 December 2018, Page 4045, https://doi.org/10.1093/eurheartj/ehy579
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Extract
A 42-year-old female patient was referred to our institution for investigations in a context of recurrent pregnancy loss and history of polycythaemia from unknown cause investigated 10 years before. The patients had no complaint. Physical examination revealed digital clubbing and cyanosis (Panel E); resting oxygen saturation was 65%. A continuous murmur was heard over the right side of her chest (Panel A). Chest X-ray revealed a right hilar enlargement and (Panel B) trans-thoracic echocardiography confirmed the pulmonary artery (PA) dilatation with an abnormal branch division of the right PA. Computed tomography (CT) revealed a giant proximal pulmonary arteriovenous malformation (PAVM) between the right PA and draining into an abnormal right pulmonary vein, explaining the whole clinical presentation (Panel C: 3D CT volume rendering—posterior view; *pulmonary arteriovenous malformation; Panel D: frontal view; the colour purple indicates the distal connection of the PAVM—Ao, aorta; AVM, arteriovenous malformation; LA, left atrium; LV, left ventricle; RIPV, right inferior pulmonary vein; RPA, right PA). Cardiac magnetic resonance assessed the flow in the PAs (imbalance with increased output within the fistula). Pre-operative angiography (Panel F, selective contrast injection into the right branch of the PA) and catheterization confirmed the normal pulmonary vascular resistance. Brain magnetic resonance revealed an asymptomatic cerebellar stroke. Multi-modality imaging helped characterizing this PAVM and allowed to choose surgery for our patient given the size of the fistula. The patient underwent ligation of the PAVM under thoracotomy successfully.