{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T19:41:03Z","timestamp":1769283663394,"version":"3.49.0"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T00:00:00Z","timestamp":1724716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Arteriovenous malformations (AVMs) within the mediastinum are rare vascular anomalies. With the increasing number of coronary angiographies being performed, the number of incidentally found cases is rising. This presents challenges in terms of determining the appropriate treatment strategy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present the case of a 79-year-old man with aortic stenosis, experiencing functional dyspnoea and fatigue. Echocardiography showed a bicuspid aortic valve, and while left heart catheterization confirmed no significant coronary stenosis, it revealed a tortuous vessel originating from the circumflex artery (Cx), assumed to be heading toward the pulmonary circulation. The patient was scheduled for a surgical replacement of the aortic valve (SAVR). During the SAVR, the tortuous vessel was revealed to be a large, complex AVM located in the mediastinum. This increased both the duration of the surgery and the use of cardioplegia. Further, bleeding occurred per-operatively. Post-operatively, the patient developed tachy-brady syndrome and was treated with a pacemaker before discharge.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Due to the rarity of incidental AVMs in the middle\/posterior mediastinum, no standard treatment protocol is available. This leaves clinicians and surgeons to manage the disease on a case-by-case basis, often with limited experience to guide their decisions. This patient case underscores the challenge of determining whether patients should be offered transcatheter aortic valve implantation (TAVI) or surgery. Furthermore, it highlights the intricate challenges that can arise when dealing with thoracic AVMs during cardiac procedures, emphasizing the importance of pre-operative awareness and tailored surgical approaches based on multidisciplinary discussions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae454","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T19:24:26Z","timestamp":1724786666000},"source":"Crossref","is-referenced-by-count":0,"title":["Mediastinal mayhem: the challenges of incidental thoracic arteriovenous malformations\u2014a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4647-7715","authenticated-orcid":false,"given":"Louise","family":"Tram","sequence":"first","affiliation":[{"name":"Department of Radiology, Aalborg University Hospital , 9000 Aalborg , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip","family":"Freeman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aalborg University Hospital , Aalborg , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4651-8983","authenticated-orcid":false,"given":"Robert Johannes","family":"Leusink","sequence":"additional","affiliation":[{"name":"Department of Radiology, Aalborg University Hospital , 9000 Aalborg , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,8,27]]},"reference":[{"key":"2024091010413361400_ytae454-B1","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1016\/j.jcin.2021.02.044","article-title":"Coronary artery fistulas","volume":"14","author":"Al-hijji","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"key":"2024091010413361400_ytae454-B2","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1097\/RTI.0000000000000232","article-title":"Coronary-pulmonary artery fistulas: a systematic review","volume":"31","author":"Verdini","year":"2016","journal-title":"J Thorac Imaging"},{"key":"2024091010413361400_ytae454-B3","doi-asserted-by":"crossref","first-page":"2853","DOI":"10.1016\/j.radcr.2021.07.015","article-title":"Arteriovenous malformation in the middle mediastinum with spontaneous hemoptysis and successful management by endovascular","volume":"16","author":"Anil","year":"2021","journal-title":"Radiol Case Reports"},{"key":"2024091010413361400_ytae454-B4","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1136\/thoraxjnl-2017-211243","article-title":"Dieulafoy\u2019s disease with mediastinal arteriovenous malformation","volume":"73","author":"Zhi","year":"2018","journal-title":"Thorax"},{"key":"2024091010413361400_ytae454-B5","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"},{"key":"2024091010413361400_ytae454-B6","first-page":"1","article-title":"Transcatheter versus surgical aortic valve replacement in patients with cardiac surgery: meta-analysis and systematic review of the literature","volume":"7","author":"Latif","year":"2020","journal-title":"J Cardiovasc Dev Dis"},{"key":"2024091010413361400_ytae454-B7","doi-asserted-by":"crossref","first-page":"e000753","DOI":"10.1136\/openhrt-2017-000753","article-title":"Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017 European guidelines for the management of valvular heart disease","volume":"5","author":"Thonghong","year":"2018","journal-title":"Open Hear"},{"key":"2024091010413361400_ytae454-B8","first-page":"117","article-title":"Bicuspid aortic valves and transcatheter valve replacement: feasibility and safety","volume":"18","author":"Gherasie","year":"2023","journal-title":"Maedica"},{"key":"2024091010413361400_ytae454-B9","first-page":"288","article-title":"Bradyarrhythmia development and permanent pacemaker implantation after cardiac surgery","volume":"5","author":"Turkkan","year":"2018","journal-title":"North Clin Istanbul"}],"container-title":["European Heart Journal - 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