Treatment of multiple unilateral arteriovenous pulmonary fistulae by transection of the pulmonary artery.

Multiple arteriovenous fistulae of the entire left pulmonary lobe were found to be the cause of increasing cyanosis on exertion and hour-glass nails in a 19-year-old patient. The right-to-left shunt amounted to 16%. The 2 possible forms of treatment were embolization of the arteriovenous fistulae or pneumonectomy. The first procedure was unsuitable because of the diffuse spread of the fistulae. In order to avoid all the early and late complications associated with a pneumonectomy, an unusual method was adopted: The left pulmonary artery was transected and the lung was left in place as a "physiological filling". Both a subjective and objective improvement could already be seen in the immediate postoperative period. At the last follow-up examination, 16 months after the operation, this was still the case.