Presentation on theme: "Thoracoscopic Right Middle Lobectomy for a Centrally Located Pulmonary AV Fistula M. R. Reidy, D. Kwazneski, R. J. Landreneau, O. Awais."— Presentation transcript:
Thoracoscopic Right Middle Lobectomy for a Centrally Located Pulmonary AV Fistula M. R. Reidy, D. Kwazneski, R. J. Landreneau, O. Awais
Background Pulmonary AV fistulas are an abnormal connection between the pulmonary arteries and veins This connection allows shunting of unoxygenated blood and possible right to left embolization. These lesions are typically managed by angiographic coil embolization. As the lesions become larger or more central, embolization therapy become limited as coils can enter the heart Our patient underwent a successful thoracoscopic right middle lobectomy with resulting decreased shunt, and no longer required oxygen utilization
History A 76 year old female seen in clinic presented with a history of new onset dyspnea requiring 2 L home oxygen and recent recurrent Transient Ischemic Attacks and migraines. Her oxygen saturation without supplemental O2 was in the low 80’s. She was known to have a pulmonary arteriovenous fistula seen radiographically as early as 1995, but only recently had she become symptomatic Labarotory workup was significant for a PaO2 of 70 on room air, and a calculated shunt fraction of 19.9%.
CT Chest computed tomography (CT) with contrast enhancement showed a large fistulous connection involving the right middle pulmonary arteries and vein measuring 4.5 X 3.8 X 2.6 cm.
Operative Findings A right middle lobectomy was safely performed with the fistula being completely excised Upon entering the chest the fistula was easily identifiable along the oblique fissure
Conclusions In this case, the fistula was both large and central, this precluded coil embolization Complications of embolization include coil or balloon migration as well as recannalization of the tract Open surgical treatments as well as video assisted thoracoscopic methods are available and effective Limitations to a less invasive closure of the AVM by coils include a centrally located, large malformation where coil migration to the left atrium is possible In these cases a lobectomy is still the preferred treatment option