Uchiyama Y, Minami H, Yamashita M, Azuma K, Takahashi T, Nakamura A
Nihon Kyobu Geka Gakkai Zasshi. 1989 Jul;37(7):1396-9.
The patient was a 61-year-old female, complaining of cyanosis, dyspnea and shortness of breath on exertion. She was diagnosed as having a pulmonary arteriovenous fistula (PAVF) in combination with mitral stenosis. The fistula was located in the left lower lobe and a right-left shunt of 28.7% was detected. Cardiac catheterization showed a pulmonary artery pressure of 44/22 mmHg (mean pressure, 31 mmHg). By occluding the PAVF using a balloon catheter, PaO2 increased from 47 mmHg to 88 mmHg. The mitral stenosis of this patient was though to be a mild form, and PAVF seemed to be responsible for symptoms. Since left lobectomy together with mitral valve replacement was considered to have a high risk, left lower lobectomy was performed initially. Thereafter mitral valve replacement was done successfully. Separate operations for PAVF and mitral stenosis are likely to be beneficial in patients with mitral stenosis associated with moderate pulmonary hypertension.
患者为一名61岁女性，主诉有发绀、呼吸困难及活动时气短。她被诊断为患有肺动静脉瘘（PAVF）合并二尖瓣狭窄。瘘位于左下叶，检测到有28.7%的右向左分流。心导管检查显示肺动脉压为44/22 mmHg（平均压，31 mmHg）。通过使用球囊导管封堵PAVF，动脉血氧分压（PaO2）从47 mmHg升至88 mmHg。该患者的二尖瓣狭窄被认为是轻度的，PAVF似乎是症状的原因。由于左肺叶切除加二尖瓣置换术被认为风险较高，最初进行了左下肺叶切除术。此后二尖瓣置换术成功完成。对于合并中度肺动脉高压的二尖瓣狭窄患者，分别对PAVF和二尖瓣狭窄进行手术可能是有益的。
