Fetal left pulmonary artery-to-left atrial fistula with aplasia of the left lung: successful postnatal transcatheter closure.

IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Bilgehan Betül Biçer, Hayrettin Hakan Aykan, Tevfik Karagöz, Ercan Tutar
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引用次数: 0

Abstract

Introduction: In the presence of fetal cardiomegaly, when there is no cardiac malformation or dysfunction, systemic or pulmonary arteriovenous malformations that may cause volume loading should be sought. We aimed to present a fetus who had cardiomegaly and left pulmonary artery-left atrial fistula and who underwent transcatheter closure in the early postnatal period.

Case presentation: 23-week fetus referred because of severe cardiomegaly on screening obstetric ultrasonography. Fetal echocardiography revealed fistulous connection between dilated left pulmonary artery and left atrium with high velocity continuous flow at the left atrial orifice of fistula and retrograde flow from the ductus arteriosus to the pulmonary artery. Initially, the fetus followed by one-to-two weeks intervals for fetal heart failure and hydrops fetalis. Pregnancy was uneventful and the baby was born by caesarean section at 37 weeks, and oxygen saturation level was 95 %. Transthoracic echocardiography confirmed the prenatal diagnosis of a fistula between the left pulmonary artery and the left atrium (CTA showed left lung aplasia. Transcatheter closure was performed from antegrade route with Amplatzer Piccolo® Duct Occluder due to hypoxaemia. The baby showed normal growth and development at 15 months of ageThere is no pulmonary hypertension during the 15-month follow-up.

Discussion: Pulmonary artery-to-left atrial fistula is a rare anomaly and is frequently described between the right pulmonary artery and the left atrium. Presentation of age depends on the size of the fistulous connection. Patients with large connections are presented in fetal age with cardiomegaly and heart failure or presented in early infancy with profound cyanosis. Although lung hypoplasia has been reported in patients with pulmonary artery-to-left atrial fistula/connection lung aplasia has never been reported in these patients. Surgical or transcatheter closure can be achieved successfully in these patients at neonatal period or early infancy like in our case.

胎儿左肺动脉-左心房瘘伴左肺发育不全:产后经导管关闭成功。
在胎儿心脏肿大的情况下,当没有心脏畸形或功能障碍时,应寻求可能导致容量负荷的全身或肺动静脉畸形。我们的目的是提出一个胎儿谁有心脏肥大和左肺动脉-左心房瘘和谁接受经导管关闭在产后早期。病例介绍:23周胎儿在产科超声检查中发现严重心脏肥大。胎儿超声心动图显示扩张的左肺动脉与左心房有瘘连接,左心房瘘口高速连续血流,动脉导管向肺动脉逆行血流。最初,胎儿随后是1 - 2周的胎儿心力衰竭和胎儿水肿间隔。妊娠顺利,婴儿于37周剖腹产出生,血氧饱和度95%。经胸超声心动图证实产前诊断为左肺动脉与左心房间瘘(CTA显示左肺发育不全)。由于低氧血症,使用Amplatzer Piccolo®导管闭塞器从顺行路线进行经导管关闭。患儿15月龄生长发育正常,随访15个月无肺动脉高压发生。讨论:肺动脉-左心房瘘是一种罕见的异常,经常发生在右肺动脉和左心房之间。年龄的表现取决于瘘管连接的大小。大连接的患者在胎儿期表现为心脏肿大和心力衰竭,或在婴儿早期表现为深度紫绀。尽管肺动脉左房瘘/连接患者有肺发育不全的报道,但这些患者中从未报道过肺发育不全。手术或经导管关闭可以成功地实现这些患者在新生儿期或早期婴儿期像我们的情况。
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来源期刊
Cardiology in the Young
Cardiology in the Young 医学-小儿科
CiteScore
1.70
自引率
10.00%
发文量
715
审稿时长
4-8 weeks
期刊介绍: Cardiology in the Young is devoted to cardiovascular issues affecting the young, and the older patient suffering the sequels of congenital heart disease, or other cardiac diseases acquired in childhood. The journal serves the interests of all professionals concerned with these topics. By design, the journal is international and multidisciplinary in its approach, and members of the editorial board take an active role in the its mission, helping to make it the essential journal in paediatric cardiology. All aspects of paediatric cardiology are covered within the journal. The content includes original articles, brief reports, editorials, reviews, and papers devoted to continuing professional development.
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