Cover image
Giant pulmonary arteriovenous malformation revealed by recurrent pregnancy loss
Pamela Moceri1,2*, Yann Diascorn1,3, Jean-Philippe Berthet1,4, and Emile Ferrari1,2
1Université Côte d’Azur, Faculté de Médecine, 28, avenue Valombrose NICE Cedex 2, France; 2CHU de Nice, Hôpital Pasteur 1, Service de Cardiologie, Avenue de la voie romaine, CS, Nice, France; 3CHU de Nice, Hôpital Pasteur 2, Service de Radiologie, Avenue de la voie romaine, CS, Nice, France and 4CHU de Nice, Hôpital Pasteur 1, Service de Chirurgie Thoracique, Avenue de la voie romaine, CS, Nice, France
*Corresponding author. Tel: +33 4 92037733, Fax: +33 4 92038516, Email: [email protected]
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.
Volume 39, Issue 45, 01 December 2018
Issue @ A Glance
Atrial fibrillation: overall cardiovascular risk beyond stroke and current management
CardioPulse
Alter ego(s) in coronary artery disease: Insights from a recently departed patient
CANTOS: One year on: When the findings of the CANTOS trial were unveiled at ESC Congress 2017 in Barcelona, there was a sense of hope that a new era in preventive cardiology was set to begin. One year on, CANTOS Principle Investigator and study author Paul M. Ridker discusses whether that optimism is being realized
Adult congenital heart disease at the Royal Brompton: A historical perspective and future directions discussed by Michael Gatzoulis
Surgical occlusion of the left atrial appendage: it is time to adopt newer techniques!
The Swiss Heart Foundation
New EHJ International Associate Editor
Fast Track Clinical Research
Atrial fibrillation
A randomized controlled trial of atrioventricular junction ablation and cardiac resynchronization therapy in patients with permanent atrial fibrillation and narrow QRS
Editorial
Biventricular pacing after AV-node ablation for atrial fibrillation with heart failure: something old and something new, future standard, or just for the few?
Clinical Research
Atrial fibrillation
Increasing population height and risk of incident atrial fibrillation: the Copenhagen City Heart Study
Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014
Association of metabolic syndrome with non-thromboembolic adverse cardiac outcomes in patients with atrial fibrillation
