Abstract
Abstract
Background
The first description of right pulmonary artery-to left atrium communication was done by Friedlich and coauthors in 1950. The right pulmonary artery and left atrium are directly connected by the right pulmonary artery to left atrial fistula through a thin-walled aneurysm. Here, we describe a female adult patient who underwent investigation for dyspnea and had Type 1 right pulmonary artery to left atrium connection.
Case presentation
Twenty-two-year-old female presented with history of breathlessness (New York Heart association classification grade III) for 3 years. On initial examination, her saturation was 60% with no clinical evidence of cyanosis. Initial radiographic examination and CT pulmonary angiogram revealed a dilated communication between the right inferior pulmonary artery and left atrium. The patient was then referred for cardiac MRI. The MR imaging showed the following findings: Dilated right ventricle and atrium with Ostium secundum type of atrial septal defect. Large focal outpouching was noted arising from the right inferior pulmonary artery whose inferomedial portion appeared to communicate with left atrium. The final diagnosis was right pulmonary artery to left atrial fistula-Type I with ostium secundum type atrial septal defect. Midline sternotomy was performed for ligation of this fistula with septal correction. Post surgery, patient began to improve clinically and her saturation in room air increased to 92%
Conclusions
Right pulmonary artery to left atrial fistula is different from the pulmonary AV fistula and its rarity directs the need for imaging to diagnose the condition and for management selection. The fistulous connection, which most frequently originates from the posterior wall of the descending branch of RPA and inserts into the LA, is readily seen on CT/catheter angiography. Due to the rarity of this entity and much fewer evidences in imaging, we have reported a type 1 right pulmonary artery to left atrium connection.
Publisher
Springer Science and Business Media LLC
Subject
Radiology, Nuclear Medicine and imaging
Reference8 articles.
1. Friedlich A, Bing RJ, Blount SG Jr (1950) 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 86:20–57
2. de Souza e Silva NAS, Giuciani ER, Ritter DG, Davis GD, Pluth JR (1974) Communication between right pulmonary artery and left atrium. Am J Cardiol 34:857–863
3. Ohara H, Ito K, Kohguchi N et al (1979) Direct communication between the right pulmonary artery and the left atrium: a case report and review of the literature. J Thorac Cardiovasc Surg 77:742–747
4. Zeebregts CJ, Nijveld A, Lam J, van Oort AM, Lacquet LK (1997) 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 11:1056–1061
5. Krishnamoorthy K (2001) Pulmonary artery to left atrial fistula. Eur J Cardiothorac Surg 20:1052–1053