Dear Editor

As well emphasized by Koppen et al,[1] congenital pulmonary arteriovenous malformation presenting in the neonatal period is an exceedingly rare anomaly, perhaps underdiagnosed. The index of suspition should be high if appropriate treatment is to be offered to these babies and, unfortunately, this was not the case in a 6-day-old patient seen by us 7 years ago.[2] Adding to the severe hypoxaemia, our case had isolated left ventricular overload demonstrated by the EKG and 2D-echo, which should have raised the strong possibility of a right to left shunt. Our index of suspition was moderate but not enough for the patient, despite attempted cardiac catheterization. This case should, in our view, be added to the other 12 mentioned by Koppen and so far reported in the literature. Also,this is perhaps the youngest patient reported and awareness of this possibility should be useful for the neonatologist.

Fernando Amaral
UNAERP Medical School

References

(1) S Koppen, CRW Korver, M Dalinghaus, CJJ Westermann. Neonatal pulmonary arteriovenous malformation in hereditary haemorrhagic telangiectasia. Arch Dis Child Fetal Neonatal 2002; 87:F226-F227.

(2) Amaral FTV, Félix PR, Granzotti JA, Rugolo LMS, Bernardes TA, Nunes MA. Fístula arteriovenosa pulmonar maciça. Causa rara, potencialmente curável de hipóxia neonatal. Arq Bras Cardiol 1995; 66:353- 355.