Novel Technique in the Management of a Patient With Pulmonary Arteriovenous Malformation and Biventricular Non Compaction

Background: Transcatheter device closure has become the primary treatment modality for pulmonary arteriovenous malformations. When compared to lobectomy or vessel ligation, this approach is much less destructive and allows for selective closure of the arteriovenous malformation while preserving the normal branching vessels and lung parenchyma. But, often the procedure is cumbersome due to anatomical and procedural factors. Case Presentation: We report the case of a 19 year old lady with biventricular non compaction and pulmonary arteriovenous fistula. She had deep cyanosis due to right to left shunt at two levels, through the stretched open patent foramen ovale due to severe right ventricular dysfunction and through the pulmonary arteriovenous malformation. The two feeders of the malformation were closed by device closure. The second feeder was closed by creating a venovenous loop via the patent foramen ovale, the pulmonary vein and through the pulmonary arteriovenous malformation into the pulmonary artery. To the best of our knowledge, this technique has never been described before in literature.Conclusion: This is a novel technique in the closure of pulmonary arteriovenous malformations, particularly in tortuous vessels which augment the difficulty in the placement of the delivery sheath and delivery of the occluder device.