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Case Reports in Pediatrics
Volume 2017 (2017), Article ID 2841720, 5 pages
Case Report

Pulmonary Arteriovenous Malformation Causing Systemic Hypoxemia in Early Infancy

1Department of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX, USA
2Department of Pediatric Cardiology, Nicklaus Children’s Hospital, Miami, FL, USA

Correspondence should be addressed to V. Aggarwal

Received 17 December 2016; Accepted 20 February 2017; Published 8 March 2017

Academic Editor: Hitoshi Horigome

Copyright © 2017 V. Aggarwal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pulmonary arteriovenous malformation (AVM) is not routinely appreciated during the standard echocardiogram to assess for structural abnormalities or pulmonary hypertension. The distal pulmonary AVM is suspected only if an injection of agitated saline is performed and late entry of particles is appreciated in the left heart structures. A large or complex pulmonary AVM can result in significant right-to-left shunting and consequential systemic hypoxemia in the presence or absence of pulmonary hypertension. For direct visualization of the pulmonary AVM, computerized tomography (CT) scan is the procedure of choice. Here, we present two young infants with systemic hypoxemia who underwent standard medical management including mechanical ventilation and one patient was placed on extracorporeal membrane oxygenation (ECMO) before the diagnosis of pulmonary AVM was established. Subsequently, both patients have done well into mid-term follow-up after being treated successfully using transcatheter occlusion techniques in the cardiac catheterization laboratory during early infancy. We aim to emphasize the importance of a high index of suspicion for pulmonary AVM in infants with refractory systemic hypoxemia of unclear etiology.