# Unveiling the complexity: coexistence of rheumatic heart disease and pulmonary arteriovenous malformation—a unique case report

## TL;DR

A rare case of a patient with both rheumatic heart disease and pulmonary arteriovenous malformation is reported, highlighting the challenges in diagnosis and treatment.

## Contribution

This case report presents a unique clinical scenario of coexisting rheumatic heart disease and pulmonary arteriovenous malformation with a tailored treatment approach.

## Key findings

- The patient showed improvement in oxygen saturation after percutaneous mitral balloon valvuloplasty and PAVM closure.
- A multidisciplinary approach was essential for managing the dual pathologies effectively.
- Staged interventions were necessary to address both cardiac and pulmonary conditions.

## Abstract

The coexistence of rheumatic heart disease (RHD) and pulmonary arteriovenous malformation (PAVM) is a rare clinical scenario that poses diagnostic and therapeutic challenges. This case report explores the clinical presentation, diagnostic journey, and multidisciplinary management of a patient presenting with both conditions.

A 47-year-old female with a history of RHD presented with symptoms of dyspnoea on exertion and cyanosis, suggestive of both cardiac involvement and pulmonary involvement. Subsequent investigations involving imaging, echocardiography, and invasive pulmonary angiography revealed the coexistence of RHD and multiple PAVM in the patient’s left lower lobe of the lung. The patient underwent a tailored treatment plan, initially involving percutaneous mitral balloon valvuloplasty for RHD, followed by a staged procedure of transcatheter PAVM closure with Amplatzer™ Vascular Plug II performed 1 month later. Her saturation normalized following the intervention. The patient’s progress was monitored closely, with adjustments made to the treatment plan based on evolving clinical scenarios. The patient remained well in short-term follow-up.

This case highlights the complexity of managing patients having two diverse conditions RHD and PAVM coexisting together, thus emphasizing the importance of a multidisciplinary approach. The unique intersection of cardiac and pulmonary pathologies necessitates careful consideration of diagnostic nuances and tailored treatment strategies. Lessons learned from this case offer valuable insights for clinicians encountering similar scenarios and underscore the significance of individualized, patient-centred care in optimizing outcomes for those with dual pathologies.