Charaniya Riyaz, Shah Jayal, M Apoorva
Department of cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Asarwa, Ahmedabad 380016, Gujarat, India.
Eur Heart J Case Rep. 2024 May 9;8(6):ytae239. doi: 10.1093/ehjcr/ytae239. eCollection 2024 Jun.
The coexistence of rheumatic heart disease (RHD) and pulmonary arteriovenous malformation (PAVM) is a rare clinical scenario that poses diagnostic and therapeutic challenges. This case report explores the clinical presentation, diagnostic journey, and multidisciplinary management of a patient presenting with both conditions.
A 47-year-old female with a history of RHD presented with symptoms of dyspnoea on exertion and cyanosis, suggestive of both cardiac involvement and pulmonary involvement. Subsequent investigations involving imaging, echocardiography, and invasive pulmonary angiography revealed the coexistence of RHD and multiple PAVM in the patient's left lower lobe of the lung. The patient underwent a tailored treatment plan, initially involving percutaneous mitral balloon valvuloplasty for RHD, followed by a staged procedure of transcatheter PAVM closure with Amplatzer™ Vascular Plug II performed 1 month later. Her saturation normalized following the intervention. The patient's progress was monitored closely, with adjustments made to the treatment plan based on evolving clinical scenarios. The patient remained well in short-term follow-up.
This case highlights the complexity of managing patients having two diverse conditions RHD and PAVM coexisting together, thus emphasizing the importance of a multidisciplinary approach. The unique intersection of cardiac and pulmonary pathologies necessitates careful consideration of diagnostic nuances and tailored treatment strategies. Lessons learned from this case offer valuable insights for clinicians encountering similar scenarios and underscore the significance of individualized, patient-centred care in optimizing outcomes for those with dual pathologies.
风湿性心脏病（RHD）与肺动静脉畸形（PAVM）并存是一种罕见的临床情况，带来了诊断和治疗方面的挑战。本病例报告探讨了一名同时患有这两种疾病的患者的临床表现、诊断过程及多学科管理情况。
一名有风湿性心脏病病史的47岁女性出现劳力性呼吸困难和发绀症状，提示心脏和肺部均受累。随后进行的包括影像学、超声心动图和有创肺血管造影等检查显示，该患者在左下肺同时存在风湿性心脏病和多处肺动静脉畸形。患者接受了定制的治疗方案，最初针对风湿性心脏病进行经皮球囊二尖瓣成形术，1个月后分阶段进行经导管使用Amplatzer™血管封堵器II型封堵肺动静脉畸形的手术。干预后患者的血氧饱和度恢复正常。对患者的病情进展进行密切监测，并根据不断变化的临床情况调整治疗方案。患者在短期随访中情况良好。
本病例突出了管理同时患有风湿性心脏病和肺动静脉畸形这两种不同疾病的患者的复杂性，从而强调了多学科方法的重要性。心脏和肺部病变的独特交集需要仔细考虑诊断细微差别和定制治疗策略。从本病例中吸取的经验教训为遇到类似情况的临床医生提供了宝贵的见解，并强调了以患者为中心的个体化护理对于优化患有双重病变患者的治疗效果的重要性。
