폐동맥고혈압 동반여부에 따른 폐동정맥루의 치료

Two Case of Pulmonary Arteriovenous Fistula Treatment Depending on the Presence of Pulmonary Hypertension

  • 허윤정 (연세대학교 의과대학 소아과학교실) ;
  • 김정태 (연세대학교 의과대학 소아과학교실) ;
  • 최재영 (연세대학교 의과대학 소아과학교실)
  • Huh, Yun Jeong (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, Jeong Tae (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Choi, Jae Young (Department of Pediatrics, Yonsei University College of Medicine)
  • 투고 : 2004.09.01
  • 심사 : 2004.10.07
  • 발행 : 2005.02.15

초록

폐동정맥루는 폐동맥 고혈압의 유무에 따라 치료가 달라진다. 따라서 폐동정맥루 치료 전 반드시 폐동맥압을 측정하여야 한다. 이에 저자들은 폐동맥 고혈압이 없어 폐동맥 색전술로 치료한 1례와 폐동맥 고혈압이 동반되어 항응고제를 투여하면서 관찰 중인 1례를 보고하는 바이다.

Pulmonary arteriovenous fistulas(PAVFs) is a rare disorder that occurs in two to three children per 100,000 population. It is presented as absence of intervening capillary beds between the pulmonary artery and vein with resultant persistent right to left shunt. Other causes include trauma, liver cirrhosis, malignancy and schistosomiasis. It is mostly asymptomatic, but it may present with respiratory difficulty, cyanosis, clubbed fingers induced by right to left shunt or hemoptysis, polycythemia and epistaxis. Major complications, such as brain abscess, brain embolism, paradoxical embolism and subacute infective endocarditis can be devastating, so therapeutic intervention is recommended in all patients. However, removal of low-resistance fistulas can aggrevate pulmonary hypertension, so detection of increased pulmonary pressure is important. We report two patients : One a 42 year-old male with PAVFs treated with coil embolization, and a 42 year-old female who was treated with anticoagulants due to pulmonary hypertension.

키워드

참고문헌

  1. Churton T. Multiple aneurysms of the pulmonary artery. Br Med J 1897;1:1223
  2. Hodgson CH, Kaye RL. Pulmonary arteriovenous fistula and hereditary hemorrhagic telangiectasia : a review and report of 35 cases of fistula. Dis Chest 1963;43:449-55 https://doi.org/10.1378/chest.43.5.449
  3. Kang SM, Kim MK, Chi JG. Pulmonary arteriovenous fistula in childhood : Report of a case. Korean J Pathol 1992; 26:201-3
  4. Kim JH, Choi TH, Nam SM, Chang JJ, Park YH, Hur NH, et al. Treatment of multiple pulmonary arteriovenous fistulas with terapeutic embolization in Osler-Rendu-Weber syndrome. Tuberculosis Respir Dis 1997;44:914-21 https://doi.org/10.4046/trd.1997.44.4.914
  5. Kuwon ES, Park WK, Ryu JS, Kwak SM, Lee HL, Jo CH, et al. A Case of Pulmonary Arteriovenous Fistula with Family History. Tuberculosis Respir Dis 1998;46:649-53
  6. Pick A, Deschamps C, Stanson AW. Pulmonary arteriovenous fistula : presentation, diagnosis, and treatment. World J Surg 1999;23:1118-22 https://doi.org/10.1007/s002689900634
  7. Sanda A, Dalzell E, Craig B, Shields M : Multiple intrapulmonary arteriovenous fistulas in childhood. Pediatr Cardiol 2000;21:493-6 https://doi.org/10.1007/s002460010120
  8. Gudavalli A, Kalaria VG, Chen X, Schwarz KQ. Intrapulmonary arteriovenous shunt : Diagnosis by saline contrast bubbles in the pulmonary veins. J Am Soc Echocardiography 2002;15:1012-4 https://doi.org/10.1067/mje.2002.121435
  9. Dieter RA. Resection of pulmonary arterovenous fistula. J Thorac Cardiovasc Surg 2001;122:386-8. https://doi.org/10.1067/mtc.2001.113742
  10. Rodan BA, Godwin JD, Chen JTT, Ravin CE. Worsening pulmonary hypertension after resection of arteriovenous fistula. AJR 1981;137:864-6 https://doi.org/10.2214/ajr.137.4.864
  11. Sperling DC, Cheitlin M, Sullivan RW, Smith A. Pulmonary arteriovenous fistulas with pulmonary hypertension. Chest 1977;6:753-7
  12. Roux BTL, Gibb BH, Wainwright J. Pulmonary arteriovenous fistula with bilharzial pulmonary hypertension. Br Heart J 1970;32;571-4 https://doi.org/10.1136/hrt.32.4.571
  13. Yoshida F, Terasawa A, Hosoe M, Mishima N, Suzuki M, Goshima K. Long term observation of a case of pulmonary arteriovenous fistula with pulmonary hypertension. Int Med 1995;34:574-6 https://doi.org/10.2169/internalmedicine.34.574
  14. Tylor BG, Cockerill EM, Manfredi F, Klatte EC. Therapeutic embolization of the pulmonary artery in pulmonary arteriovenous fistula. Am J Med 1978;64:360-5 https://doi.org/10.1016/0002-9343(78)90066-9
  15. Liau CS, Wang JK, Wu MH, Chu IT. Transcatheter closure of a huge pulmonary arteriovenous fistula with embolization coils. Cathet Cardiovas Diagn 1997;42:286-9 https://doi.org/10.1002/(SICI)1097-0304(199711)42:3<286::AID-CCD12>3.0.CO;2-K
  16. Berman W, Fripp RR, Raisher BD, Yabek SM. Transcatheter occlusion of large pulmonary arteriovenous fistula. Cathet Cardiovas Diagn 2000;51:220-2 https://doi.org/10.1002/1522-726X(200010)51:2<220::AID-CCD20>3.0.CO;2-L