Mahapatra R, Mahanta D, Singh J, Acharya D, Barik R. Device closure of fistula from left lower pulmonary artery to left atrium using a vascular plug: A case report. World J Cardiol 2021; 13(4): 111-116 [PMID: 33968310 DOI: 10.4330/wjc.v13.i4.111]
Corresponding Author of This Article
Ramachandra Barik, DNB, MD, Academic Research, Reader (Associate Professor), Department of Cardiology, All India Institute of Medical Sciences, Sijua Patrapada, Bhubaneswar Pin-751019, Odisha, India. cardioramachandra@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rudrapratap Mahapatra, Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bhubaneswar Pin-751019, Odisha, India
Dibyasundar Mahanta, Jogendra Singh, Debasis Acharya, Ramachandra Barik, Department of Cardiology, All India Institute of Medical Sciences, Bhubaneswar Pin-751019, Odisha, India
Author contributions: Barik R planned, performed the device closure and wrote the manuscript; Mahapatra R was the cardiothoracic surgeon who suggested device closure and supported editing of the manuscript; Mahanta D and Singh J supported the intervention as a fellow in training; Acharya D assisted in the planning of the case management and helped during the procedure.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: The authors have no conflicts of interests or financial disclosures relevant to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramachandra Barik, DNB, MD, Academic Research, Reader (Associate Professor), Department of Cardiology, All India Institute of Medical Sciences, Sijua Patrapada, Bhubaneswar Pin-751019, Odisha, India. cardioramachandra@gmail.com
Received: December 13, 2020 Peer-review started: December 13, 2020 First decision: February 28, 2021 Revised: March 1, 2021 Accepted: April 14, 2021 Article in press: April 14, 2021 Published online: April 26, 2021 Processing time: 129 Days and 0.8 Hours
Abstract
BACKGROUND
Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly. Delayed presentation, cyanosis and effort intolerance are some of the important features. The diagnosis is confirmed by computed tomography or pulmonary artery angiography. Catheter-based closure is preferred to surgery.
CASE SUMMARY
Left pulmonary artery-to-left atrial fistula is rare. A 40-year-old male presented with effort intolerance, central cyanosis, and recurrent seizures. He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course. Catheter-based closure was performed using a vascular plug.
CONCLUSION
Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula. Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred. The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath, necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.
Core Tip: Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly. Left pulmonary artery-to-left atrial fistula is rare. We report the case of a 40-year-old male who presented with effort intolerance, central cyanosis, and recurrent seizures. He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course. Catheter-based closure was performed using a vascular plug.
