Congenital Vertebral Arteriovenous Fistula

Excerpt

A 21-mo-old female was referred from an outside clinic for closure of a small Patent Ductus Arteriosus (PDA). On examination she was found to have a 3/6 continuous murmur heard best at the right infraclavicular region. An echocardiogram was repeated in our hospital where a PDA could not be identified, although there was holodiastolic flow reversal in the descending aorta with flow going to the innominate artery (Fig. 1a). Patient was subsequently taken to the cardiac catheterization laboratory where angiogram confirmed the absence of a PDA, but there was an abnormal fistulous communication between the right vertebral artery and vertebral vein (Fig. 1b). Further magnetic resonance imaging with magnetic resonance angiography (MRI/MRA) of head and neck vessels confirmed the diagnosis (Fig. 1c). The patient clinically had no symptoms of congestive heart failure or neurological symptoms, and hence decision was made to proceed with conservative management at this time with close follow-up.

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