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F I J R O I ’ E A N
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luimpcuii J o u r n a l o f C u id i o - t h o i i i d c S u r f e r ) ' ]1 <l W > 1 0 5 6 -1 0 6 1
Surgical treatment of a fistula between the right pulmonary artery and
presentation
of
two
cases
and
review
of
the left
C.J.A.M. Zeebregts “•*, A. N ijveld 11, J. Lam b, A .M . van O o r tc, L.K. L a cq u et“
a Department of Thoracic and Cardiac Surgery, Childrens Heart Centre, University Hospital Nijmegen St. Radboud, P.O. Box 9101,
6500 HB Nijmegen* The Netherlands
h Department o f Pediatric Cardiology, University Hospital Amsterdam A M C, Amsterdam, The Netherlands
c Department o f Pediatric Cardiology, Children's Heart Centre, i/w rm /fy Hospital Nijmegen St. Radboud, P.O. 5o.v 9 W L
6500 H B Nijmegen, 77it' Netherlands
Received 9 September 1996; received in revised form 22 January 1997; accepted 22 January 1997
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, anatom y, 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. 0 1997 Elsevier Science B.V.
Keywords: Cerebral abscess; Cyanosis; Extracorporeal circulation; Right pulm onary artery -left atrium fistula
1. Introduction
2. Case reports
A direct communication between the right pul­
monary artery (RPA) and the ieft atrium (LA) is a rare
anomaly. Central cyanosis with clubbing of fingers and
toes, exertional dyspnea and decreased arterial oxygen
saturation usually accompany the lesion. Complications
are cerebral and systemic emboli, cerebral abscesses and
rupture of the fistula. On the basis of our two cases and
a literature review, we focus on clinical presentation,
anatomy, diagnosis and the role of surgical correction,
as complete cure can be achieved by ligation and possi­
ble division of the fistula or by intracardiac repair.
2.Î. Case A
* Corresponding author. Tel.: +31 24 3614744; fax- + 3 1 24
3540129.
1(110-7940/97/517.00
1997 Elsevier Science B.V. AU rights reserved.
PII S 10 I 0 - 7 94 0 ( 9 7 ) 0 ! I 7 2 - X
A 4-year-and-3-months-old girl was admitted to hos­
pital because of sleeping problems. She had severe
cyanosis and, in retrospect, her mother stated, that for
many years she had had a cyanotic color. On examina­
tion, a cyanotic girl was seen, 110 cm tall and weighing
17.5 kg. Her blood pressure was 95/65 mm ITg. She had
cyanosis of the lips and limbs with clubbing of the
fingers. No tachypnea, dyspnea, or murmurs were
noted. Liver and spleen were not palpable. Laboratory
examination showed a hemoglobin concentration (Hb)
of 11.7 mmol/1, a hematocrit (Ht) of 0.57 and a platelet
count of 244 x 109/1. Electrocardiography showed a
normal sinus rhythm. Chest X-ray revealed no abnor-
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C. J, A. M. Zeeb refits ct al.
Europ can Jour mi I o f Cardin-th or at u Si o^crv I i (¡997) J056 1(161
Table I
of all reported eases of a direct communication between the
richt pulmonary artery and the left atrium, including our two cases
[j 7.9.1 i- 1(08.20-25.27-36,38 44,46 -58]
S u n im u r )
n
(1 1
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u
• ---- ----- --
1059
a high risk of major complications. Surgical correction
is therefore preferable. In general, the fistula can easily
be ligated and divided. Procedures are also described
where the fistula is only ligated (without division) or
where an intracardiac repair is performed with the use
of ECC A lack of information about the consistency of
the fistulous tissue during extracardiac procedures may
be a reason to use ECC.
In conclusion, apart from mild cyanosis and finger
clubbing, direct communication between the right pul­
monary artery and the left atrium may give few symp­
toms, causing a significant delay in diagnosis.
Electrocardiography and chest X-ray may be com­
pletely normal. Echocardiography and cardiac catheter­
ization, including selective angiography, provide the
necessary information. To prevent complications, espe­
cially systemic and cerebral emboli, early surgical inter­
vention should be performed. Complete cure can be
achieved by ligation and possible division or by intrac­
ardiac repair.
m
Gender
Male
Female
Unspecified
37
13
1
73
25
jT
L,
Age
0-1 month
I 12 months
I -10 years
11 20 years
21 - 30 years
31 -40 years
41 50 years
5 ! “ 60 years
Unspecified
8
2
18
13
3
4
1
1
1
16
4
35
25
6
8
i**
i
Approach
Right thoracotomy (RT)
Median sternotomy (MS)
RT followed by MS
No surgery
Unspecified
28
12
1
6
4
55
24
0
12
8
Type of opera tion
Ligation
Division
Excision
Intracardiac repair
Pneumonectomy
Exploration
No surgery
Unspecified
27
6
5
4
1
1
6
1
53
12
10
8
2
2
12
O
Use of ECC
Used
Not used
No surgery
Unspecified
29
11
6
5
57
Outcome
Died
Survived
Unspecified
n
38
1
22
75
4
■**
*■ -“ «* « v *
■ » rn
12
10
-
directly into the systemic circulation, thereby bypassing
pulmonary filter function, may lead to cerebral compli­
cations. Transient ischemic attacks, cerebral infarctions
and abscesses occur more often with these fistulas
[19,34,37]. Other complications are: endocarditis, infec­
tive endarteritis and aneurysmatic growth of the fistula,
with the risk of fatal rupture.
To prevent these complications, elective surgery is
recommended [8,15,19,37]. Absolute indications for sur­
gical correction are severe cyanosis with a significantly
decreased systemic oxygen saturation or severe poly­
cythemia. It is possible to perform embolization of the
fistula without surgery [10]. However, direct communi­
cation between the RPA and LA exposes the patient to
References
[1] Abe T, Kuribayashi R, Sato M, Nieda S. Direct communication
of the right pulmonary artery with the left atrium: a case report
and review' of the literature. J Thorac Cardiovasc Surg
1972;64:38-44.
[2] Almeida OD, Cortelazzi PS. Godoy MF. Carvalho AC, Succi
JE, Andrade JC\ Buffolo E, Leuo LEV, Gallucci C. Comunieayào direta entre o ramo direito da artéria pulmonar e o atrio
esquerdo: relato de um caso e revisàû da litcratura. Arq Bras
Cardiol 1985;45:271-275.
[3] Araujo JAR, M ont’aiverne R, Paes Jr JN, Perez PE, Andrade
PJN, Jucà ER. Comunieaçao direta entre a artéria pulmonar
direita e o atrio esquerdo: relato de caso. Arq Bras Cardiol
1985;45:435-437.
[4] Arendrup H. Direct communication between the pulmonary
artery and left atrium. Seand J Thorac Cardiovasc Surg
1982; 16:157 ” 160.
[5] Auldist A, Westlake G. Fistula between the right pulmonary
artery and left atrium. Aust N Z J Surg 1968:37:240-241.
[6] Aytac A, Tuncali T. Direct communication of a pulmonary
artery with the left atrium: first reported case of all four pul«
monary veins entering the communication. J Thorac Cardiovasc
Surg 1967;54:553-556.
[7] Balil VK, Balachander J, G upta RK, Kaul UA, Sharma SR,
Khalilullah M. Direct communication between pulmonary artery
and left atrium. Indian Heart J 1983;35:234-237.
[8] Batinica S, Gagro A, Bradic I, Marinovic B. Congenital pul­
monary arferio-vcnous fistula: a rare cause of cyanosis in child­
hood. Thorac Cardiovasc Surg 1991;39:105-106.
[9] Bauersfeld SR, Zuberbuhler JR, Ford WB. Right pulmonary
artery left atrial communication. Am Heart J 1964;67:244-250.
[10] Beck FJ, Neuerburg J, Sigmund M, Schmitz E, Günthe: RW,
Hanrath P. Steigerung der kardiopulmonalen Belastbarkeit
durch Embolisation einer arterio-venosen Lungenfistel. Dtsch
Med Wochenschr 1993;118:1193-1198.
[11] Biodina B, Sutlic, Husedinovic 1, Marinovic B, Sokolic J, Direct
communication between the pulmonary artery and the left
atrium. Lijeô Vjesn (Croatia) 1993;115:160-162.
1060
CJ.A'M , Zeebregts et al. / European Journal oj Cardia-thoracic Surgery 11 (1997) 1056 /061
[12] Camilleri L, Gabrillargucs J, Lemaire JJ, Legault B, Brazzalotto
1, Bailiy P, Lusson JR, de Riberolles C. Fistule arterio-veineuse
pulmonaire congenitale: a propos de deux observations. Arch
Mai Coeur 1995;88:767-770.
[13] Castleman B, Kibbee BU, Case records of the Massachusetts
General Hospital: case 45231. N Engl J Med 1959;260:1 ISO1186.
[14] Cheatham JP, Barnhart DA, Gutgesell HP. Right pulmonary
artery to left atrium communication: an unusual cause of
cyanosis in the newborn. Pediatr Cardiol 1982;2:149-152.
[15] Clarke CP, Goh TH, Blackwood A, Venables AW. Massive
pulmonary arteriovenous fistula in the newborn. Br Heart J
1976;38:1092-1095.
[16] De Souza e Silva NA, Giuliani HR, Ritter DG, Davis GD, Pluth
JR. Communication between right pulmonary artery and left
atrium. Am J Cardiol 1974;34:857-863.
[17] Fried R, Amberson JB, O'Loughlin JE, Cruz SB, Sniderman
K.W, Firpo AB, Engle MA. Congenital pulmonary arteriovenous
fistula producing pulmonary arterial steal syndrome. Pediatr
Cardiol 1982;2:313-318.
[18] Friedlich A, Bing RJ, Blount Jr SG. Physiological studies in
congenital heart disease: IX. Circulatory dynamics in the anoma­
lies of venous return to the heart including pulmonary arteri­
ovenous fistula. Bull Johns Hopkins Hosp 1950;86:20-57.
[19] Gelfand MS, Stephen DS, Howell E, Alford RH, Kaiser AB,
Brain abscess: association with pulmonary arteriovenous fistula
and hereditary hemorrhagic telangiectasia; report of 3 cases. Am
J Med 1988;85:718-720.
[20] Gupta S, Ghose BB, Sen Gupta AN. Direct communication
between pulmonary artery and left atrium: report of a case with
a suggested classification of the defect In: Anand MP, Goyal
BK, editors. Progress in vascular diseases, Bombay: ArnoldHcinmann, 1978;164-171.
[21] Hope JW, Borns PF, Koop CE. Radiologic diagnosis of me­
diastinal masses in infants and children. Radiol Clin North Am
1963;1:17-50.
[22] Ito T, Yokota H, Murata H, Nakahara M, Kodama K, Kitamura S, Kawashima Y. Direct communication between the
pulmonary artery and the left atrium: a case report and review of
the literature. J Cardiovasc Surg 1986;27:108-112.
[23] Itoh I, Ha mad a Y, Urushikubo K, Sakauchi M, Satoh Y,
Makinae T, Niitu K, Yamazaki N. Direct communication of the
right pulmonary artery with the left atrium; a case report and
review of the literature. J Jpn Assoc Thorac Surg 1982;30:1865—
1872.
[24] Jimenez M, Fournier A, Choussat A. Pulmonary artery to the
left atrium fistula as an unusual cause of cyanosis in the new­
born. Pediatr Cardiol 1989;10:216-220.
[25] Kaplan S. Pulmonary arteriovenous fistula. In: Watson H, edi­
tor. Pediatric cardiology XIX. London: Lloyd-Luke, 1968:316319.
[26] Karnik AM, Nilsson U, Vijaayaraghavan G, Hashmi J,
Shuhaiber H, Direct communication between the left pulmonary
artery and the left atrium. Chest 1989;96:937-939.
[27] Kashani IA, Gaitan P, Grdver M, Swensson RE, Snyder JM,
Utley JR. Right pulmonary artery-left atrial communication: a
case report and literature review. Jpn Heart J 1984;25:139-145.
[28] Kawada S, Koide S, Yamazki S, Shohtsu A, Kato S, Watabe T,
Matsuyama M, Flata J. Direct communication of the right
pulmonary artery and the left atrium associated with accessory
cardiac bronchus. J Jpn Assoc Thorac Surg 1977;25:1497-1503.
[29] Kawamura T, Osawa M, Morikawa T, Usuda T, Kosukegawa
K. Direct communication of the right pulmonary artery with the
left atrium; a case report and the considerations of diagnosis and
surgical treatment. Heart (Shinzo) 1978;10:937-943.
[30] Krause DW, Kuehn HJ, Sellers RD, Wilson WJ, Roentgen sign
associated with an aberrant vessel connecting right main pul­
monary artery to left atrium. Radiology 1974; 111:177-178.
[31] Krocker EJ, Adams HD, Leon AS, Pouget JM. Congenital
communication between a pulmonary artery and the left atrium:
physiologic observations and review of the literature. Am J Med
1963;34:721-725.
[32] Lekuona I, Cabrera A, Inguunzo R, Cid C, Agosti J. Direct
communication between the right pulmonary artery and the left
atrium. Thorax 1986;41:78- 79.
[33] Lemoine G, Thibert M, Leca F t Rolland JC, AUegraud P,
Temkinc J. Communication entre artère pulmonaire droite et
oreillette gauche: revue de la littérature à propos d'une observa­
tion. Arch Mal Coeur 1979;72:552-558.
[34] Lucas Jr RV, Lund GW, Edwards JE. Direct communication of
a pulmonary artery with the left atrium: an unusual variant of
pulmonary arteriovenous fistula. Circulation I% 1;24:1409 1414.
[35] Miao WZ, Qian JQ, Chen XY, Shao SC, Wang S, Chen E,
Direct communication between right pulmonary artery and left
atrium: a case report. Chin Med J 1984;97:623- 626.
[36] Moreno F, Quero M, Pérez V, Alvarez F. Direct communication
of a pulmonary artery with the left atrium. Bull Am Coll Chest
Phys 1975;14:39-43.
[37] Moss A.J., Adams F.IT. Heart disease in infants, children, and
adolescents, 5th edn. Baltimore: Williams and Wilkins, 1995.
[38] Nagai I, Kawashima Y, Fujita S, Miyamoto T, Naitô Y, Manabe H. Direct communication of a pulmonary artery to the left
atrium. J Jpn Assoc Thorac Surg 1972;20:683-689.
[39] Nonoyama A, Itano T, Takimoto R, Miyamoto I, Katsuya H,
Kotani S, Kagawa T. An unusual variant of pulmonary arteri­
ovenous fistula. J Jpn Thorac Surg 1966; 14:404 407.
[40] Oda T, Lin YT, Masaki H. Direct communication of the right
pulmonary artery with the left atrium in an infant. Jpn J Surg
1982;12:224-226.
[41] Ohara H, Ito K, Kohguchi N, Ohkawa Y, Akasaka T, Takarada
M, Aoki H, Ogata M, Nishibataka M, Fukatsu O, Matsushima
K, Sasaki Y, Direct communication between the right pul*
monary artery and the left atrium: a case report and review of
the literature. J Thorac Cardiovasc Surg 1979;77:742 -747.
[42] Okishima T, Sato Y, Yamamoto K, Matsuoka Y, Sennari E,
ITayakawa K, Tomita M, Koga Y, Shibata R. A case of the
direct communication between right pulmonary artery and the
left
atrium. Heart (Shinzo) 1981;13:350-356,
*■
[43] Okten T, Okumuç Y, Kurtoglu S. Direct communication be­
tween pulmonary artery and left atrium. Turk J Pediatr
1995;37:177-181.
[44] Orlick AE, Hultgren N, Stoner JD, Barry WH, Wexler L, Dong
Jr EV. Traumatic pulmonary artery-left atrial fistula: an un­
usual case of cyanosis in an adult. Am Heart J 1979;98:366-370.
[45] Perloff JK. The clinical recognition of congenital heart disease,
4th edn. Philadelphia: WB Saunders, 1994.
[46] Rolland JC, Thibert M, Lebranchu Y, Lemoine G, Lejars O.
Fistule artério-veineuse entre artère pulmonaire droite et oreil­
lette gauche: revue de la littérature à propos d’une observation,
Sem Hop Paris 1980;56:853-861.
[47] Sassolas F, Long JL, Bozio A, Joeteur-Monrozier D, Andre M,
Normand J, Champsaur G. Communication artère pulmonaire
droite-oreillette gauche: une cause rare d’hypoxie réfractaire
chez le nouveau-né. Pediatrie 1984;39:203-208.
[48] Sawant D, Nair KK. Unusual variant of pulmonary arteri­
ovenous communication. Eur J Cardio-thorac Surg 1993;7:164165.
[49] Sheikhzadeh A, Hakim H, Ghabusi P, Ataii M, Tarbiat S. Right
pulmonary artery-to-left atrial communication: recognition and
surgical correction. Am Heart J 1984;107:396-398.
[50] Sloan RD, Cooley RN, Congenital pulmonary arteriovenous
aneurysm. Am J Roentgenol 1953;70:183-210.
[51] Stuckey S. Direct communication between the right pulmonary
artery and the left atrium: magnetic resonance findings. Australas Radiol 1993;37:216-220,
C J . A . M . Zech regt s et al. / European Journal o f Cardio-thoracic Surgery 11 (1997) 1056-1061
[52] Subramanian N, Vasudevan S, Tajmul Hussain A. Direct commu­
nication of a pulmonary artery with left atrium: report of a case
with balloon occlusion studies and succesful correction: a case
report. Angiology 1986;37:136-141.
[53] Taussig MB. Congenital malformations of the heart, 2nd edn.,
Vol. 2. Cambridge, MA; Harvard University Press, 1960;376—379.
[54] Teramoto S, Ono K, Fuji H, Ehara Y, Kaneko H, Oishi K,
Sunada T. Direct communication of the right pulmonary artery
with left atrium. Jpn J Thorac Surg 1973;26:781- 785.
[55] Tuneali T, Aytac A. Direct communication between right pul­
monary artery and left atrium; report of a case and proposal of
1061
a new entity. J Pediatr 1967;71:384-389.
[56] Verel D, Grainger RG, Taylor DG. Direct communication of a
pulmonary artery with the left atrium. Br Heart J 1964;26:856858.
[57] Von Loogen F, Wolter HH. Über einen ungewöhnlichen arterio­
venösen Kurzschluß im Lungenkreislauf. Z Kreislaufforsch
1957;46:328 -333.
[58] Wojtalik M, Moll J, Szkutnik M, Frycz M, Religa Z, Zembala M,
Grzybowski A, Kucewicz E, Goldstein L, Przybylski R, Fartnas
A. A case of direct right pulmonary artery-left atrium fistula.
Kardiol Pol 1992;37:317-319.