Off label use of atrial septal occluder in huge arterio-venous malformation with giant aneurysm.

Pulmonary arterio-venous fistula (PAVF) is an uncommon cause of cyanosis and should be suspected when normal cardiac examination is associated without evidence of intra-cardiac shunt. Off-label use of occluder devices in the catheter laboratories can be helpful and safe when chosen according to the morphology, site, and the size of the fistula, and it is considered a good alternative to surgery as it selectively occludes the PAVF while preserving the normal pulmonary vessels. Our case was a young boy accidentally discovered and diagnosed as having huge PAVF, after false diagnosis of coronavirus disease 2019. The fistula was successfully closed using septal occluder device which is not common to use such device in such lesion. Follow up with computed tomography pulmonary angiogram confirmed the closure results with good device position and no residual shunt. Learning objectives: 1To encourage the use of simple non-invasive tools like pulse oximeter that can help in the diagnosis of clinically un-discovered de-saturated patients.2To be malleable with the different occluder devices and be able to use any, according to the lesion you have to close not only those that they were designed for.