Device closure of fistula from left lower pulmonary artery to left atrium using a vascular plug: A case report.

Background: Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly. Delayed presentation, cyanosis and effort intolerance are some of the important features. The diagnosis is confirmed by computed tomography or pulmonary artery angiography. Catheter-based closure is preferred to surgery.

Case Summary: Left pulmonary artery-to-left atrial fistula is rare. A 40-year-old male presented with effort intolerance, central cyanosis, and recurrent seizures. He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course. Catheter-based closure was performed using a vascular plug.

Conclusion: Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula. Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred. The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath, necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.