Notsuda Hirotsugu, Tomiyama Fumiko, Onodera Ken, Watanabe Tatsuaki, Watanabe Yui, Oishi Hisashi, Niikawa Hiromichi, Inoue Chihiro, Ota Hideki, Noda Masafumi, Okada Yoshinori
Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University Hospital, Tohoku University, 4-1, Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Egypt Heart J. 2023 Dec 21;75(1):103. doi: 10.1186/s43044-023-00431-9.
Systemic-to-pulmonary artery shunt (SPAS) is a rare condition that can occur as a result of congenital heart disease or chronic pulmonary inflammation, occasionally leading to life-threatening hemoptysis. Computed tomography (CT) imaging is crucial in the diagnosis of SPAS, and the optimal management approach for SPAS remains uncertain. This case report presents a novel approach to the treatment of SPAS, consisting of transcatheter arterial embolization of the systemic artery followed by lung segmentectomy.
A 42-year-old man with abnormal chest findings was referred to us and a diagnosis of SPAS was established based on the CT findings showing a blood flow regurgitation from the dilated left 4th intercostal artery to the Lt. A6. The patient was asymptomatic but we decided to treat him to prevent a risk of future hemoptysis. Transcatheter arterial embolization (TAE) of systemic arteries followed by S6 segmentectomy was successfully performed with minimal blood loss and complete removal of the dilated intra-pulmonary blood vessels. Histological analysis confirmed the diagnosis of SPAS.
We reported a case of SPAS, who was successfully treated with the combination of TAE and subsequent segmentectomy. The blood loss during surgery was minimal and this strategy appeared to minimize future recanalization and hemoptysis. Further studies and long-term follow-up of SPAS patients are required to establish standardized management guidelines for this rare condition.
体肺分流（SPAS）是一种罕见的病症，可由先天性心脏病或慢性肺部炎症引起，偶尔会导致危及生命的咯血。计算机断层扫描（CT）成像对SPAS的诊断至关重要，而SPAS的最佳治疗方法仍不确定。本病例报告介绍了一种治疗SPAS的新方法，包括经导管动脉栓塞体动脉，随后进行肺段切除术。
一名胸部检查异常的42岁男性被转诊至我院，根据CT表现显示扩张的左第四肋间动脉向左肺A6有血流反流，确诊为SPAS。患者无症状，但我们决定对其进行治疗以预防未来咯血的风险。成功进行了体动脉的经导管动脉栓塞术（TAE），随后进行S6段切除术，术中失血极少，扩张的肺内血管被完全切除。组织学分析证实了SPAS的诊断。
我们报告了一例SPAS患者，通过TAE联合后续段切除术成功治疗。手术期间失血极少，该策略似乎可最大程度减少未来的再通和咯血。需要对SPAS患者进行进一步研究和长期随访，以建立针对这种罕见病症的标准化管理指南。
