One-Stop Closure of PAVF and PFO at Beijing Tiantan Hospital

🏥 Recently at Beijing Tiantan Hospital, our team managed a 22-year-old female patient.

[Diagnostic Dilemma]

🩸 The patient suffered from chronic, refractory migraines, with routine neurological workups showing no intracranial lesions.

🔬 Further evaluation via transesophageal echocardiography and enhanced pulmonary CTA confirmed the true etiology lay in cardiopulmonary structural anomalies.

💡 The patient presented with a rare coexistence of a pulmonary arteriovenous fistula (PAVF) and a patent foramen ovale (PFO).

⚠️ This dual right-to-left shunt allowed venous microthrombi and vasoactive substances to bypass the pulmonary capillary bed, directly entering the systemic circulation and cerebral vasculature.

[Surgical Nuances]

🛠️ Following a thorough MDT evaluation of this complex anatomy, we opted for a one-stop percutaneous closure strategy.

🎯 As demonstrated in the attached intraoperative DSA fluoroscopy, precise catheterization was achieved to deliver guidewires and occluders to both the pulmonary and cardiac lesions.

[Take-home Message]

✅ Simultaneous deployment was executed flawlessly, with immediate post-procedural angiography confirming stable occluder positioning and complete resolution of the right-to-left shunts.

📈 The patient's migraines completely resolved postoperatively, underscoring the critical value of tracing cryptogenic stroke risks to structural cardiopulmonary defects.