Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China.
The Research Units of West China (2018RU012) - Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, P.R. China.
BMC Pregnancy Childbirth. 2023 Aug 31;23(1):626. doi: 10.1186/s12884-023-05946-2.
Pulmonary arteriovenous fistula is rare during pregnancy. Pulmonary arteriovenous fistula presents no pulmonary symptoms in most patients but can be exacerbated by pregnancy. If not diagnosed and treated promptly, pulmonary arteriovenous fistula can lead to respiratory failure, stroke, spontaneous hemothorax, or other fatal complications.
A 29-year-old healthy pregnant woman presented with a transient drop in blood oxygen level of unknown cause during a routine examination at 34 weeks of gestation and during a cesarean section at 38 weeks of pregnancy. The patient's oxygen saturation quickly returned to normal and was not further investigated. On day 3 postpartum, the patient suddenly displayed slurred speech and right limb myasthenia. A head magnetic resonance imaging revealed cerebral infarction in the left basal ganglia. Subsequent computed tomography pulmonary arteriography revealed bilateral pulmonary arteriovenous fistula, which was likely the cause of cerebral infarction. The patient was transferred to the Department of Thoracic Surgery after one month of treatment and successfully underwent percutaneous embolization of pulmonary arteriovenous fistula.
Pulmonary arteriovenous fistula should not be neglected if a pregnant woman presents with transient hypoxemia and cerebral infarction. A transient decrease in pulse oxygen saturation that cannot be explained by common clinical causes can be an early warning sign of the disease. Early diagnosis and multidisciplinary management could improve the prognosis.
肺动静脉瘘在妊娠期间较为罕见。大多数患者的肺动静脉瘘无肺部症状，但妊娠可使其恶化。如果不能及时诊断和治疗，肺动静脉瘘可导致呼吸衰竭、中风、自发性血胸或其他致命并发症。
一位 29 岁健康孕妇在妊娠 34 周常规检查和 38 周剖宫产期间出现血氧水平不明原因的一过性下降。患者的氧饱和度很快恢复正常，未进一步检查。产后第 3 天，患者突然出现言语含糊和右侧肢体肌无力。头部磁共振成像显示左侧基底节区脑梗死。随后的 CT 肺动脉造影显示双侧肺动静脉瘘，这可能是脑梗死的原因。患者在治疗 1 个月后转至胸外科，并成功接受了肺动静脉瘘的经皮栓塞治疗。
如果孕妇出现一过性低氧血症和脑梗死，不应忽视肺动静脉瘘。无法用常见临床原因解释的一过性脉搏血氧饱和度下降可能是该病的早期预警信号。早期诊断和多学科管理可改善预后。
