Transcatheter embolization of multiple intra-pulmonary arterio-venous fistulae with Amplatzer vascular plugs

摘要

A 56-year-old male was referred for percutaneous treatment of multiple-symptomatic persistent pulmonary arterio-venous fistulae (PAVFs). The patient's history included surgical repair of a secundum-type atrial septal defect with closure of right lung PAVFs in 1961, repeat transcatheter radiofrequency ablations for recurrent episodes of intra-atrial re-entrant tachycardia, and implantation of a transvenous dual-chamber pacemaker for sick sinus syndrome in 2002. Over the subsequent years, he had developed progressive cyanosis and dyspnoea (NYHA ll-lll) with arterial desaturation from 89 to 81% during exercise, indicating significant right-to-left shunt.