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Right pulmonary artery to left atrial fistula: a description of two cases, emphasising a diagnostic approach

Published online by Cambridge University Press:  15 November 2011

Gabriel Diaz*
Affiliation:
Departamento de Pediatria Universidad Nacional de Colombia, Departamento de Pediatria Fundacion Santafe de Bogota, Bucaramanga, Colombia
Alicia Marquez
Affiliation:
Servicio de Pediatria Clinica Candelaria, Centro Policlinico Del Olaya, Clinica De La Mujer, Bucaramanga, Colombia
Javier Gentile
Affiliation:
Departamento de Cirugia Cardiovascular, Fundacion Cardiovascular de Colombia, Bucaramanga, Colombia
*
Correspondence to: Gabriel Diaz, Profesor Titular del Departamento de Pediatria, Facultad de Medicina, Universidad Nacional De Colombia, Ciudad Universitaria, Carrera 30 Number 45-03, Bogota, Colombia; Office address: Carrera 9 Number 116-20, Consultorio 332, Bogota, Colombia. Tel: +57 1 2152300, 2152920; Fax: +57 1 2150849 E-mails: [email protected], [email protected]

Abstract

Right pulmonary artery to left atrial fistula is a rare pathology characterised by a right to left shunt. Another important aspect of this pathology is the difficulty encountered in making a diagnosis, which is why the diagnosis is frequently delayed into adulthood. A description of two cases is used to emphasise the importance of the different modes of echocardiography as a diagnostic tool in diagnosis, as well as the two different clinical forms that it adopts: a group of patients suffering cardiac failure and cyanosis without apparent cause generally in neonates and a second group of mostly older patients with dyspnoea and cyanosis without apparent cause. Symptoms thus differ depending on the time of presentation and are related to the size of the fistula.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2012

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References

1.Friedlich, A, Bing, RJ, Blount, SG Jr. Physiological studies in congenital heart disease IX. Circulatory dynamics in the anomalies of venous return to the heart including pulmonary arteriovenous fistula. Bull Johns Hopkins Hosp 1950; 86: 2057.Google Scholar
2.Chowdhury, UK, Kothari, SS, Airan, B, Subramaniam, KG, Venugopal, P. Right pulmonary artery to left atrium communication (Review). Ann Thorac Surg 2005; 80: 365370.CrossRefGoogle Scholar
3.Bockeria, L, Podzolkov, V, Makhachev, O, Kim, A. Congenital direct communication between the right pulmonary artery and the left atrium: anatomic variations and surgical experience. Interact Cardiovasc Thorac Surg 2010; 10: 114115.CrossRefGoogle ScholarPubMed
4.De Souza e Silva, NA, Giuciani, ER, Ritter, DG, Davis, GD, Pluth, JR. Communication between right pulmonary artery and left atrium. Am J Cardiol 1974; 34: 857863.CrossRefGoogle ScholarPubMed
5.Ohara, H, Ito, K, Kohguchi, N, et al. . Direct communication between the right pulmonary artery and the left atrium. Case report and review of the literature. J Thorac Cardiovasc Surg 1979; 77: 742747.CrossRefGoogle ScholarPubMed
6.Russell, V, Lucas, JR, Lund, GW, Edwards, JE. Direct communication of a pulmonary artery with the left atrium. An unusual variant of pulmonary arteriovenous fistula. Circulation 1961; 24: 14091414.Google Scholar
7.Faizal, A, Sankar, NM, Murthy, KS, Cherian, KM. Right pulmonary artery-to-left atrial fistula. Asian Cardiovasc Thorac Ann 2002; 10: 8082.CrossRefGoogle ScholarPubMed
8.Küçükosmanoglu, O, Poyrazoglu, H, Topçuoglu, MS, Erdem, S, Erman, T, Ozbarlas, N. Right pulmonary artery–left atrial communication presenting with brain abscess: a case report. Turk J Pediatr 2006; 48: 373375.Google ScholarPubMed
9.Francis, E, Sivakumar, K, Kumar, RK. Transcatheter closure of fistula between the right pulmonary artery and left atrium using the Amplatzer duct occluder. Catheter Cardiovasc Interv 2004; 63: 8386.CrossRefGoogle ScholarPubMed
10.Boudjemline, Y, Ladouceur, M, Bonnet, D. Neonatal transcatheter closure of a large pulmonary arteriovenous fistula. Cardiol Young 2006; 16: 593595.CrossRefGoogle ScholarPubMed
11.Zanchetta, M, Rigatelli, G, Pedon, L, Zennaro, M, Maiolino, P, Onorato, E. Transcatheter Amplatzer duct occluder closure of direct right pulmonary artery-to-left atrium communication. Catheter Cardiovasc Interv 2003; 58: 107110.CrossRefGoogle Scholar
12.Slack, MC, Jedeikin, R, Jones, JS. Transcatheter coil closure of a right pulmonary artery to left atrial fistula in an ill neonate. Catheter Cardiovasc Interv 2000; 50: 330333.3.0.CO;2-T>CrossRefGoogle Scholar
13.Duke, C, Alwi, M. Transcatheter closure of direct communication between right pulmonary artery and left atrium using Amplatzer device. Heart 2003; 89: 1210.CrossRefGoogle ScholarPubMed
14.Francis, E, Sivakumar, K, Krishna Kumar, R. Transcatheter closure of fistula between the right pulmonary artery and left atrium using the Amplatzer duct occluder. Catheter Cardiovasc Interv 2004; 63: 8386.CrossRefGoogle ScholarPubMed
15.Karnik, AM, Nilsson, U, Vijaayaraghavan, G, Hashmi, J, Shuhaiber, H. Direct communication between the left pulmonary artery and the left atrium. Chest 1989; 96: 937939.CrossRefGoogle ScholarPubMed
16.Sambasivam, K, Dhanawade, SM, Krishnaswami, S. Direct communication between left pulmonary artery and left atrium. Indian Heart J 1995; 47: 4041.Google Scholar
17.Krishnakumar, N, Krishna, MR, Tharakan, JA. Right pulmonary artery-to-left atrial fistula: a differential diagnosis of cyanosis without structural heart disease. J Invasive Cardiol 2007; 19: 401402.Google ScholarPubMed
18.Jiménez, M, Fournier, A, Choussat, A. Pulmonary artery to the left atrium fistula as an unusual cause of cyanosis in the newborn. Pediatr Cardiol 1989; 10: 216220.CrossRefGoogle Scholar
19.Saatvedt, K, Gunnar Stake, G, Lindberg, H. Fistula between the right pulmonary artery and the left atrium – an unusual cause of cyanotic heart disease. Cardiol Young 1995; 5: 8587.CrossRefGoogle Scholar
20.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: 149152.CrossRefGoogle ScholarPubMed
21.McBrien, AH, Sands, AJ, Gladstone, DJ. A large, single pulmonary arteriovenous fistula presenting hours after birth. Images Paediatr Cardiol 2006; 28: 16.Google Scholar
22.Mohanty, SR, Yadav, R, Kothari, SS, Airan, B. Right pulmonary artery-to-left atrium communication. A rare cause of systemic cyanosis. Ann Thorac. Surg 2000; 69: 269271.CrossRefGoogle Scholar
23.Chowdhury, UK, Airan, B, Kothari, SS, Pandey, A, Subramaniam, FG, Venugopal, P. Right pulmonary artery-to-left atrium communication: report of 5 cases. Ann Thorac Surg 2005; 80: 336338.CrossRefGoogle ScholarPubMed
24.Veldtman, G, Bloackburn, MEC, Parsons, J. Congenital right pulmonary artery to left atrial fistula. Heart 1998; 80: 162.CrossRefGoogle ScholarPubMed
25.Ivert, T, Fathi, M, Forssell, G, Svane, B, Lindblom, D. Catheter-guided open ligation of a pulmonary artery to left atrium connection. Congenit Heart Dis 2008; 3: 303305.CrossRefGoogle ScholarPubMed
26.Liu, L, Xiang, W, Tiecheng, P. Congenital right pulmonary artery-to-left atrial fistula. Asian Cardiovasc Thorac Ann 2010; 18: 373375.CrossRefGoogle ScholarPubMed
27.Krishnamoorthy, KM, Rao, S. Pulmonary artery to left atrial fistula (Case Report). Eur J Cardiothorac Surg 2001; 20: 10521053.CrossRefGoogle Scholar
28.Krishnamoorthy, KM, Rao, S. Transesophageal echocardiography for pulmonary artery to left atrial fistula. Asian Cardiovasc Thorac Ann 2003; 11: 96.CrossRefGoogle ScholarPubMed
29.Meskishvili, VA, Dâhner, I, Ovroutski, S, Hetzer, R. Right pulmonary artery-to-left atrium communication: a rare cause of systemic cyanosis. Tex Heart Inst J 2001; 28: 122124.Google Scholar
30.Zeebregts, CJ, Nijveld, A, Lam, J, van Oort, AM, Lacquet, LK. Surgical treatment of a fistula between the right pulmonary artery and the left atrium: presentation of two cases and review of literature. Eur J Cardiothorac Surg 1997; 11: 10561061.CrossRefGoogle ScholarPubMed
31.Stuckey, S. Direct communication between the right pulmonary artery and the left atrium: magnetic resonance findings. Australian Radiol 2008; 37: 216220.CrossRefGoogle Scholar
32.Chikada, M, Murakami, A, Takeuchi, K, Takamoto, S. Communication between the right pulmonary artery and left atrium with aneurysm formation. Gen Thorac Cardiovasc Surg 2008; 56: 177179.CrossRefGoogle ScholarPubMed
33.Margaryan, R, Arcieri, L, Cantinotti, M, Murzi, B. Surgical closure of big pulmonary artery-left atrial fistula. Interact Cardiovasc Thorac Surg 2010; 10: 113114.CrossRefGoogle ScholarPubMed