Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT)

Kjeldsen, Anette Drøhse; Oxhøj, H; Andersen, Poul Erik; Green, Anders; Vase, P.

doi:10.1046/j.1365-2796.2000.00725.x

Cited by 117 publications

(90 citation statements)

References 24 publications

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“…Microspheres were detected in the epicardium of the left ventricle in two of our exercising dogs, suggesting that recruitment of I-P shunts could play a role in embolic heart disease. In addition, previous work has shown that stroke patients have a higher prevalence of patent foramen ovale (38)(39)(40), and hereditary hemorrhagic telangiectasia patients are more susceptible to embolic stroke and neurologic symptoms (41), indicating that blood flow bypassing the pulmonary microcirculation may have important physiological relevance. Isolated lung work has shown that I-P arteriovenous shunts are up to 420 m in diameter in the dog (11), 390 m in the cat (9), and 200 m in the adult human (13).…”

Section: Shunt Consequencementioning

confidence: 99%

Exercise-induced Arteriovenous Intrapulmonary Shunting in Dogs

Stickland

Lovering²,

Eldridge³

2007

Am J Respir Crit Care Med

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Rationale:We have previously shown, using contrast echocardiography, that intrapulmonary arteriovenous pathways are inducible in healthy humans during exercise; however, this technique does not allow for determination of arteriovenous vessel size or shunt magnitude. Objectives: The purpose of this study was to determine whether large-diameter (more than 25 m) intrapulmonary arteriovenous pathways are present in the dog, and whether exercise recruits these conduits. Methods: Through the right forelimb, 10.8 million 25-m stable isotope-labeled microspheres (BioPAL, Inc., Worcester, MA) were injected either at rest (n ϭ 8) or during high-intensity exercise (6-8 mph, 10-15% grade, n ϭ 6). Systemic arterial blood was continuously sampled during and for 3 minutes after injection. After euthanasia, tissue samples were obtained from the heart, liver, kidney, and skeletal muscle. In addition, 25-and 50-m microspheres were infused into four isolated dog lungs that were ventilated and perfused at constant pressures similar to exercise. Measurements and Main Results: Blood and tissue samples were commercially analyzed for the presence of microspheres. No microspheres were detected in the arterial blood or tissue samples from resting dogs. In contrast, five of six exercising dogs showed evidence of exercise-induced intrapulmonary arteriovenous shunting, as microspheres were detected in arterial blood and/or tissue. Furthermore, shunt magnitude was calculated to be 1.4 ؎ 0.8% of cardiac output (n ϭ 3). Evidence of intrapulmonary arteriovenous anastomoses was also found in three of four isolated lungs. Conclusions: Consistent with previous human findings, these data demonstrate that intrapulmonary arteriovenous pathways are functional in the dog and are recruited with exercise.Keywords: intrapulmonary arteriovenous anastomoses; shunt; pulmonary gas exchange; pulmonary circulationThe classic understanding of the normal pulmonary circulation is that all the blood leaving the right ventricle passes through the pulmonary microcirculation via capillaries before returning to the left side of the heart through the pulmonary venous circulation. Studies using saline contrast echocardiography in humans have demonstrated that exercise results in the transpulmonary passage of contrast bubbles, suggesting that large-diameter intrapulmonary (I-P) arteriovenous pathways are recruited with exercise (1-3). These findings are controversial in that they are in contrast with prior research, using inert gas and/or inspired 100% Previous studies, using contrast echocardiography, suggest that intrapulmonary shunts are recruited during exercise in health. However, the size of the contrast is unknown, and thus arteriovenous diameter is undefined. What This Study Adds to the FieldLarge-diameter intrapulmonary arteriovenous shunts are functional in healthy animals, and exercise recruits these vessels.oxygen (4)(5)(6)(7)(8), that has failed to detect substantial right-to-left physiological I-P shunt during exercise.Despite an absence of right-to-left I-P...

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Section: Shunt Consequencementioning

confidence: 99%

Exercise-induced Arteriovenous Intrapulmonary Shunting in Dogs

Stickland

Lovering²,

Eldridge³

2007

Am J Respir Crit Care Med

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“…3 It is the right-to-left shunt between the pulmonary artery and pulmonary vein which is the fundamental defect, 3 allowing the passage of paradoxical emboli into the systemic circulation, bypassing the pulmonary capillary filter. [4][5][6] The patient' s peripheral oxygen saturation will be typically low and as expected does not normalise with an increase in FiO 2 . 3 In contrast to other AVMs, PAVMs do not affect cardiac haemodynamics and cardiac output is usually within normal limits 3 or, due to a low pulmonary vascular resistance, is even associated with supranormal cardiac output.…”

Section: Discussionmentioning

confidence: 99%

Fatal Systemic Embolism following Revision of Hip Arthroplasty: A Complication of Pulmonary Arteriovenous Malformation

Battle¹,

Dow

Timperely

2013

Journal of the Intensive Care Society

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A 72-year-old female patient who had a pulmonary arteriovenous malformation (PAVM) suffered systemic emboli causing pulmonary and cerebral infarction following the revision of an infected total hip replacement. Although not ultimately successful in this case, we detail the management of maintaining oxygenation and adequate cardiac output in a critically ill patient with a PAVM. We also discuss techniques that may be employed to minimise the shunt associated with the PAVM, with the aim of reducing the risk of systemic emboli.

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“…Легочные АВМ наблюдаются у 15-50% больных НГТ [26][27][28]. В то же время, наличие артериовеноз ных шунтов в легких в 80-90% является проявлени ем болезни Рандю-Ослера-Вебера [28,29].…”

Section: клиника и диагностикаunclassified

“…Наиболее часто поражаемыми отдела ми ЖКТ являются желудок и тонкая кишка [27,39]. Большинство телеангиэктазий бессимптомны или вызывают клинически незначимые кровотечения [40].…”

Section: клиника и диагностикаunclassified