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Transesophageal Echocardiographic Diagnosis of Bronchopulmonary Vein Fistula Complicating Mitral Valve Replacement
Author(s) -
Hsaad Ayman Haj,
Bleich Steven,
Nanda Navin C.,
Athanasuleas Constantine L.,
Kemaloğlu Öz Tuğba
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12258
Subject(s) - medicine , pulmonary vein , fistula , mitral valve replacement , cardiology , mitral valve , vein , surgery , embolization , radiology , ablation
A bronchopulmonary vein fistula ( BVF ) establishes a communication between a pulmonary vein and the alveolar space presumably secondary to alveolar rupture from increase in alveolar pressure. This rare fistula allows air to move continuously from the lungs to a pulmonary vein and into the left side of the heart causing systemic air embolization which is often fatal. We describe an adult patient undergoing a second mitral valve replacement surgery in whom intra‐operative transesophageal echocardiography proved crucial in diagnosing BVF by showing persistent and increased streaming of air bubbles into the left heart from the left superior pulmonary vein during each positive pressure ventilation cycle with consequent inability to de‐air the heart. This allowed initiation of appropriate management. The patient eventually had a fatal outcome from multiple organ infarcts.