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H Ha ae em mo od dy yn na am mi ic cs s aan nd d g ga as s e ex xc ch ha an ng ge e b be ef fo or re e a an nd d a af ft te er r c co oi il l e em mb bo ol li iz za at ti io on n o of f p pu ul lm mo on na ar ry y a ar rt te er ri io ov ve en no ou us s m ma al lf fo or rm ma at ti io on ns s P. Andrivet*, F. Lofaso*, M-F. Carette**, J. Allegrini + , S. Adnot* Haemodynamics and gas exchange before and after coil embolization of pulmonary arteriovenous malformations. P. Andrivet, F. Lofaso, M-F. Carette, J. Allegrini, S. Adnot. ©ERS Journals Ltd 1995. ABSTRACT: A complete description of haemodynamics and gas exchange before and after percutaneous coil embolization of multiple pulmonary arteriovenous malformations is reported, in a 45 year old woman with hereditary haemorrhagic telangiectasis (HHT). Before treatment, whilst the patient complained of severe dyspnoea during daily activities, an intrapulmonary shunt of 31% was measured (inert gas elimination technique), together with a cardiac output (thermodilution technique) of 12.4 L·min -1 , resulting in a resting arterial oxygen tension (Pa,O 2 ) of 8.53 kPa.Effective occlusion of all visible pulmonary malformations resulted in a rapid and major improvement in exercise tolerance, whilst resting Pa,O 2 remained almost unchanged. A second investigation performed 4 months after treatment revealed a persistent intrapulmonary shunt of 19%, a cardiac output of 7.35 L·min -1 , and a resting Pa,O 2 of 10.53 kPa.We conclude that major increases in cardiac output largely contribute to the maintenance of Pa,O 2 in patients with multiple pulmonary arteriovenous malformations and intrapulmonary shunt. The benefit of coil embolization is due both to an improvement in arterial oxygenation and a normalization of cardiac output. Eur Respir J., 1995Respir J., , 8, 1228Respir J., -1230 Large or multiple pulmonary arteriovenous malformations (PAVM) may lead to severe and incapacitating hypoxaemia via right-to-left intrapulmonary shunts. Several reports have recently offered important clinical, gasometric and therapeutic insights into this problem [1][2][3][4]. However, a complete description and follow-up of the haemodynamic and gas exchange data, including assessment of the distribution of ventilation-perfusion ratios, has not previously been reported. The present case report describes how alterations of haemodynamics and gas exchange, observed in a 45 year old woman with hereditary haemorrhagic telangiectasia (HHT) and PAVM, were improved by therapeutic coil embolization. Case reportA female patient was investigated for increasing dyspnoea, with major impairment of her daily activities. Questioning revealed that an elder brother underwent balloon embolization in 1985 for multiple PAVM. Physical examination at rest showed a mild tachypnoea (20 breaths·min -1 ), with digital clubbing, and digital cyanosis was present whilst standing. The patient was unable to perform an exercise test of 1 min at a workload of 40 W. No cutaneous telangiectasis was present, but a previous episod...

Two out of nine patients in which inferior vena cava interruption was performed with a Günther filter developed a recurrent pulmonary embolism. In both cases, the filter had moved down and the anchoring legs had perforated the wall of the vena cava. The source of the pulmonary embolism was a clotted basket filter. Anticoagulation was given for two weeks in one patient and six months in the other after insertion of the filter, but it had been stopped before the thrombotic event leading to the recurrent pulmonary embolism. The formation of the thrombi had probably been caused by the migration of the filter and the subsequent perforation, which may have been facilitated by the cessation of the anticoagulation.

Optoelectronic plethysmography (OEP) is a noninvasive method for assessing lung volume variations and the contributions of different anatomical compartments of the chest wall (CW) through measurements of the motion of markers attached to the CW surface. The present study proposes a new method for analyzing the local CW kinematics from OEP measurements based on the kinematics of triangular Cosserat point elements (TCPEs). 52 reflective markers were placed on the anterior CW to create a mesh of 78 triangles according to an anatomical model. Each triangle was characterized by a TCPE and its kinematics was described using four time-variant scalar TCPE parameters. The total CW volume ( VTCW) and the contributions of its six compartments were also estimated, using the same markers. The method was evaluated using measurements of ten healthy subjects, nine patients with Pompe disease, and ten patients with Duchenne muscular dystrophy (DMD), during spontaneous breathing (SB) and vital capacity maneuvers (VC) in the supine position. TCPE parameters and compartmental volumes were compared with VTCW by computing the phase angles θ (for SB) and the correlation r (for VC) between them. Analysis of θ and r of the outward translation parameter PT of each TCPE revealed that for healthy subjects it provided similar results to those obtained by compartmental volumes, whereas for the neuromuscular patients the TCPE method was capable of detecting local asynchronous and paradoxical movements also in cases where they were undistinguished by volumes. Therefore, the TCPE approach provides additional information to OEP that may enhance its clinical evaluation capabilities.