title: Large fetal pulmonary arteriovenous fistula: impact on pulmonary development.
abstract: A case report of a patient with a large pulmonary arteriovenous fistula and valvar pulmonary stenosis is presented. The fistula was diagnosed prenatally and its effect on in utero cardiovascular growth and development documented. Due to concerns about massive intrapulmonary shunting potentially causing profound cyanosis after delivery, an EXIT (EX-utero Intrapartum Treatment) procedure was used to transfer the infant from placental to extracorporeal membrane oxygenation (ECMO) support. Severe pulmonary microvascular disease resulted in prohibitive pulmonary hypertension despite surgical ligation of the fistula. Prenatal and postnatal hemodynamic assessments of the fistula are presented and are compared to the pathologic findings.
authors.affiliation: University of Michigan, F1310 MCHC/Box 0204, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0204, USA. mruss@umich.edu
authors.forename: M W
authors.initials: MW
authors.lastname: Russell
authors.forename: C
authors.initials: C
authors.lastname: Gomez
authors.forename: C
authors.initials: C
authors.lastname: Nugent
authors.forename: J
authors.initials: J
authors.lastname: Christiansen
mesh_terms: D001164:Arteriovenous Fistula; D004452:Echocardiography; D005260:Female; D005333:Fetus / Q000002:abnormalities* / Q000098:blood supply*; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000254:growth & development; D011247:Pregnancy; D011667:Pulmonary Veins; D019043:Vascular Neoplasms / Q000556:secondary