Transcardiac retrograde transvenous embolization of proximally occluded pulmonary arteriovenous malformation
To report a novel transcardiac retrograde transvenous coil embolization of inadequately proximally occluded pulmonary arteriovenous malformation (AVM). Pulmonary AVM in the right A4 segment in an 8-year-old boy with hereditary hemorrhagic telangiectasia was initially treated by proximal occlusion of the feeding artery with coils. 6 years later, recurrent AVM caused dyspnea on exertion. The A4 AVM was reperfused by many collaterals from local pulmonary arteries. Via the Brockenbrough procedure, an 8F-long sheath was introduced from right atrium to left atrium. A 7F balloon catheter was then coaxially introduced into right middle pulmonary vein. Then a microcatheter was introduced retrogradely from pulmonary vein to pulmonary artery through the recurrent AVM. The venous sac and the distal arterial segment of the A4 AVM were successfully embolized with detachable coils. The A4 AVM was completely occluded. No adverse effects were observed, and dyspnea on exertion disappeared. This novel transcardiac retrograde transvenous embolization is useful for inadequately treated pulmonary AVM with proximal feeding artery occlusion.