Traumatic pulmonary arteriovenous fistula may be misdiagnosed with residual shunt after patent foramen ovale closure

Abstract

SummaryWe report the case of a 48-year-old woman with a history of transient ischaemic attacks (TIA). The patient was diagnosed with a large patent foramen ovale (PFO), for which she underwent percutaneous PFO closure. Two years postprocedurally, the patient suffered frequent TIA and assessment showed the displacement of the device. The device was surgically removed, and the septum was repaired with a pericardial patch. Afterward, however, the patient experienced repeat TIA. It was discovered that the patient had a pulmonary arteriovenous fistula (PAVF), and a diagnosis of a trauma was made. The PAVF was later coil embolised. This case illustrates the importance of evaluating PFO closure patients for the associated causes of right-to-left shunting. BACKGROUND

Transient ischemic attack induced by pulmonary arteriovenous fistula：a case report

“…Cases of cerebral ischemic stroke induced by PAVF were mostly reported in adults, which is attributed to paradoxical cerebral embolism (PCE). [1][2][3][4][5] PCE was caused by the transfer of emboli from venous to artery, or from right heart system to left heart system, because of the existence of congenital or acquired arteriovenous communication. PCE is mostly induced by patent foramen ovale (PFO), 6 while PAVF is a potential rare cause.…”

Traumatic pulmonary artery injury: a review of the recent literature

“…If an abnormal connection between an artery and a vein occur, this is called as an arteriovenous (AV) fistula. In a trauma setting, arterial fistulas can be asymptomatic or characterized by right ventricular dysfunction, acute respiratory failure or transient ischemic attack (TIA) [8][9][10][11][12] . Traumatically, fistulas occur between the PA and left atrium, internal mammary artery, aorta or pulmonary vein.…”