All issues > Volume 33(6); 1990

Original Article

J Korean Pediatr Soc. 1990;33(6):835-841. Published online June 30, 1990.

Treatment of Congenital Pulmonary Arteriovenous Fistula with Therapeutic Embolization in a Child.

Byung Hee Kim¹, Young Soo Chun¹, Jin Soo Choi¹, Jae Sook Ma¹, Tai Ju Hwang¹, Jae Kyu Kim²

¹Department of Pediatrics, Chonnam University Medical School, Kwyangju, Korea
²Departmant of Radiology, Chonnam University Medical School, Kwyangju, Korea

Received: March 20, 1990;  Accepted: April 3, 1990.

Abstract

Congential pulmonary arteriovenous fistula is an uncommon malformation which has an abnormal connection between the pulmonary capillary bed, in which venous blood in the pulmonary artery is shunted through the fistula into the pulmonary vein without exposure to alveolar air, enters the left heart, and results in systemic arterial unsaturation, polycythemia, cyanosis and clubbing. Death often results from cerebral abscess and rupture of the malformation with massive hemor- rhage. Therapeutic intervention is recommended for all symptomatic patients because of the risk of those serious complications. Treatment options include surgery and transcatheter obliteration with steel coils or detachable balloons. Because of the rarity of the condition, many decisions are still emperical. Therapeutic embolization has the adventages that multiple bilateral pulmonary arteriovenous malformations can be occluded and also that the procedure can be repeated if necessary. Most experience of this technique has been delivered in adults and older children. A 4-year old child with congenital pulmonary arteriovenous fistula, who had cyanosis and hemoptysis, was treated with embolization technique using steel coils. After the first therapeutic embolization, significant improvement of arterial blood gas values with disappearance of cyanosis was noted. However, 3 months later, cyanosis with significant arterial oxygen unsaturation was reappered. Thus the second procedure was performed, and then the patient became free from symptoms. During the subsequent 12 months follow up period, he had no symptoms or complications.

Keywords :Pulmonary arteriovenous fistula, Therapeutic embolization