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She initially stabilized with diuresis, afterload reduction and supplemental oxygen. However, two weeks after admission she developed worsening pulmonary edema and hypoxemia with a Po2 value of 51 mm Hg while breathing 100 percent Os. She was intubated, mechanically ventilated and treated for congestive heart failure. Complete pulmonary angiography followed by coil spring occlusion of her AVFs was performed. Two large and two small right lower lobe AVFs and the previously detected left lower lobe AVF were selectively catheterized and successfully occluded (Fig 2). The Po2 value improved and was 358 mm Hg while the patient was breathing 100 percent 02, and she was successfully extubated. She remained hospitalized for the next four weeks due to congestive heart failure. At 30 weeks’ gestation, labor was induced and a healthy male infant was delivered vaginally. She did well following delivery and was discharged while receiving diuretics, digoxin and afterload reduction. A shunt study done one month after discharge revealed a Po2 value while breathing room air of 85 mm Hg, a Po2 value while breathing 100 percent Os of 531 mm Hg, and shunt a fraction of 7 percent. Figure 2. Right pulmonary angiogram. A, Prior to embolization, showing multiple right lower lobe AVFs. B, Following embolization.