Mahapatra Rudrapratap, Mahanta Dibyasundar, Singh Jogendra, Acharya Debasis, Barik Ramachandra
Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bhubaneswar Pin-751019, Odisha, India.
Department of Cardiology, All India Institute of Medical Sciences, Bhubaneswar Pin-751019, Odisha, India.
World J Cardiol. 2021 Apr 26;13(4):111-116. doi: 10.4330/wjc.v13.i4.111.
Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly. Delayed presentation, cyanosis and effort intolerance are some of the important features. The diagnosis is confirmed by computed tomography or pulmonary artery angiography. Catheter-based closure is preferred to surgery.
Left pulmonary artery-to-left atrial fistula is rare. A 40-year-old male presented with effort intolerance, central cyanosis, and recurrent seizures. He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course. Catheter-based closure was performed using a vascular plug.
Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula. Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred. The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath, necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.
肺动脉至左心房瘘是肺动静脉瘘的一种变异，属于发育异常。症状出现较晚、发绀和劳力不耐受是其一些重要特征。通过计算机断层扫描或肺动脉造影可确诊。与手术相比，基于导管的封堵术更为可取。
左肺动脉至左心房瘘较为罕见。一名40岁男性出现劳力不耐受、中心性发绀和反复发作的癫痫。他有一个巨大且高度迂曲的左肺动脉至左心房瘘，瘘管行程中伴有一个巨大的动脉瘤样囊。采用血管封堵器进行了基于导管的封堵术。
与右肺动脉至左心房瘘相比，左肺动脉至左心房瘘相对少见。首选经房间隔技术或通过肺动脉将导丝插入肺静脉进行经皮封堵。是否需要动静脉环取决于瘘管行程的迂曲程度以及要植入装置的大小，因为较大的装置需要更大的鞘管，这就需要牢固的导丝支撑，以利于推送鞘管和扩张器的硬组合顺利通过。
