title: Surgical treatment of a fistula between the right pulmonary artery and the left atrium: presentation of two cases and review of literature.
abstract: OBJECTIVE
  A direct communication between the pulmonary artery and the left atrium is a rare anomaly. On the basis of two cases of our own and a literature review of 49 cases, we focus on clinical presentation, anatomy, diagnosis, and the role of surgery.
  
  
  METHODS
  Two cases of a fistula between the right pulmonary artery and the left atrium are described in a girl of 4 years and a boy of 15 years. Both presented with unexplained cyanosis. Diagnosis was made on echocardiography and angiography. The fistula was ligated using extracorporeal circulation in the first case and not in the second case.
  
  
  RESULTS
  The surgical results were successful with resolution of the cyanosis.
  
  
  CONCLUSIONS
  In newborns, urgent surgery may be necessary. In other patients, early elective surgical correction should be performed to prevent complications, especially systemic and cerebral emboli, cerebral abscesses, and rupture of aneurysmal fistulas. Complete cure can be achieved by ligation and possible division or by intracardiac repair.
authors.affiliation: Department of Thoracic and Cardiac Surgery, Children's Heart Centre, University Hospital Nijmegen St. Radboud, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: A
authors.initials: A
authors.lastname: Nijveld
authors.forename: J
authors.initials: J
authors.lastname: Lam
authors.forename: A M
authors.initials: AM
authors.lastname: van Oort
authors.forename: L K
authors.initials: LK
authors.lastname: Lacquet
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D017023:Coronary Angiography; D003490:Cyanosis / Q000209:etiology; D004452:Echocardiography; D005260:Female; D005402:Fistula / Q000601:surgery*; D006325:Heart Atria / Q000002:abnormalities*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities*