[A case of pulmonary arteriovenous fistula with mitral stenosis]

The patient was a 61-year-old female, complaining of cyanosis, dyspnea and shortness of breath on exertion. She was diagnosed as having a pulmonary arteriovenous fistula (PAVF) in combination with mitral stenosis. The fistula was located in the left lower lobe and a right-left shunt of 28.7% was detected. Cardiac catheterization showed a pulmonary artery pressure of 44/22 mmHg (mean pressure, 31 mmHg). By occluding the PAVF using a balloon catheter, PaO2 increased from 47 mmHg to 88 mmHg. The mitral stenosis of this patient was though to be a mild form, and PAVF seemed to be responsible for symptoms. Since left lobectomy together with mitral valve replacement was considered to have a high risk, left lower lobectomy was performed initially. Thereafter mitral valve replacement was done successfully. Separate operations for PAVF and mitral stenosis are likely to be beneficial in patients with mitral stenosis associated with moderate pulmonary hypertension.