title: Rare case of pulmonary arteriovenous fistula simulating residual defect after transcatheter closure of patent foramen ovale for recurrent paradoxical embolism.
abstract: We report on a patient suffering from recurrent cerebrovascular events despite previous transcatheter closure of persistent foramen ovale (PFO) with a Helex occluder. There was evidence of persistent left-to-right atrial shunt shown by transesophageal contrast echocardiography and the patient was admitted to our institution for interventional closure of the supposed residual defect. However, the PFO was completely closed by the device and left pulmonary artery injections showed a pulmonary arteriovenous fistula in the left lower lobe. This rare malformation may well explain the recurrent paradoxical embolism. Transcatheter fistula closure with coils was performed successfully. This case underlines that the existence of an isolated pulmonary arteriovenous fistula as a right-to-left shunt in patients with cryptogenic stroke should not be overlooked, even if a PFO is present and pulmonary arteriovenous fistula is not suggested by the initial physical findings or chest X-ray.
authors.affiliation: Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany. peters@dhzb.de
authors.forename: Bjoern
authors.initials: B
authors.lastname: Peters
authors.forename: P
authors.initials: P
authors.lastname: Ewert
authors.forename: S
authors.initials: S
authors.lastname: Schubert
authors.forename: H
authors.initials: H
authors.lastname: Abdul-Khaliq
authors.forename: P E
authors.initials: PE
authors.lastname: Lange
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects; D002404:Catheterization / Q000009:adverse effects*; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008168:Lung / Q000098:blood supply; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012008:Recurrence; D017211:Treatment Failure