Quantification of right to left shunt through pulmonary arteriovenous malformations using 99Tcm albumin microspheres

Chilvers, Edwin R.; Peters, A. M.; George, Phyllis; Hughes, J. M. B.; Allison, D J

doi:10.1016/s0009-9260(88)80065-5

Cited by 46 publications

(32 citation statements)

References 6 publications

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“…[3][4][5][6][7][8] These defined right-to-left shunting as the predominant cause of hypoxemia in PAVM patients, [3][4][5][6][7][8] and demonstrated that increased flow through PAVMs is matched by an increase in cardiac output and total pulmonary blood flow (alveolar and shunt), in proportion to the R-L shunt fraction.…”

Section: Discussionmentioning

confidence: 99%

“…The resting SaO2 of the highest tertile were slightly lower than those of the 12 controls (96-99%). Five PAVM patients acted as their own controls, by performing a second study [3][4][5][6][7][8][9][10][11][12] (median 6) months post embolization, when chest x-rays demonstrated PAVM sac obliteration and reduced caliber of draining veins (eFigure2). The second exercise study was performed with higher resting SaO2 (94-96%, median 96%) compared to pre embolization for the same patients (88-94%, median 90%, p=0.009 ( Figure 1A, left-hand boxes)).…”

Section: Pavm Patient Demographicsmentioning

confidence: 99%

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Cardiopulmonary Exercise Testing Demonstrates Maintenance of Exercise Capacity in Patients With Hypoxemia and Pulmonary Arteriovenous Malformations

Howard

Santhirapala

Murphy

et al. 2014

Chest

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Section: Discussionmentioning

confidence: 99%

Section: Pavm Patient Demographicsmentioning

confidence: 99%

Cardiopulmonary Exercise Testing Demonstrates Maintenance of Exercise Capacity in Patients With Hypoxemia and Pulmonary Arteriovenous Malformations

Howard

Santhirapala

Murphy

et al. 2014

Chest

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“…The percentage of radiolabelled macroaggregates shunted from pulmonary to systemic circulation was calculated by the equation proposed by GATES et al [12]: This is a quantitative measure of the percentage of cardiac output flowing through vessels >15 µm in diameter. This method has been documented to give estimates of shunt that closely correspond with those measured by the classical O 2 method, both in pulmonary disease with known large arterio-venous (A-V) malformations [13] and in intracardiac right-left (R-L) shunts [12]. Using the same batch of macroaggregates, whole body scintiscans were performed on two patients with suspected pulmonary emboli on days 1 and 3, and the calculated shunt estimates were 3 and 4%, respectively.…”

Section: Subject and Methodsmentioning

confidence: 90%

Pulmonary vascular dilatation and diffusion-dependent impairment of gas exchange in liver cirrhosis

Crawford¹,

Regnis²,

Laks³

et al. 1995

Eur Respir J

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the actual presence of diffusion-limitation for oxygen. Thus, significant inequality of alveolar ventilationperfusion ratios (V'A/Q') could equally explain a marked improvement in arterial Pa,O 2 with 100% oxygen breathing. Indeed, recent studies using the multiple inert gas elimination technique (MIGET), an analysis which can indirectly detect oxygen diffusion-limitation, have attributed the arterial hypoxaemia in patients with liver cirrhosis to V'A/Q' inequality and intrapulmonary shunting [9][10][11]. However, none of these MIGET studies has providedany direct evidence of actual pulmonary vascular dilatation; and, hence, they do not, by themselves, invalidate the specific hypothesis that diffusionlimitation for oxygen can occur as a direct consequence of abnormal dilatation of interalveolar vessels.To adequately test the above hypothesis requires an experimental approach that has the power to simultaneously Eur Respir J, 1995, 8, 2015-2021 DOI: 10.1183 ABSTRACT: To test the hypothesis that diffusion-limitation for oxygen is due to abnormal vascular dilatation and significantly contributes to the arterial hypoxaemia of liver cirrhosis requires an experimental approach that detects both diffusion-limitation for oxygen and the presence of abnormal dilatation of pulmonary vessels exposed to alveolar gas. We therefore studied the gas exchange of a 64 year old man with alcoholic liver cirrhosis and severe resting arterial hypoxaemia (arterial oxygen tension (Pa,O 2 ) 7.5 kPa) whilst breathing air and 100% O 2 using conventional blood gas (CBG) analysis, the multiple inert gas elimination technique (MIGET) and whole body scintigraphy (WBS) following the i.v. administration of radiolabelled boli of macroaggregates with a minimum diameter of 15 µM.During air breathing, there was a consistently positive difference between the arterial oxygen tension predicted by MIGET and that actually measured (P-M Pa,O 2 , average 0.9 kPa). During O 2 breathing, P-M Pa,O 2 became negative, (average -12.2 kPa), and shunt estimated by the O 2 method (% of Q') was consistently less than that measured by MIGET. Whereas both O 2 method and MIGET estimates of shunt never exceeded 25%, the WBS shunt was 40%, indicating that a substantial fraction of cardiac output flowed through abnormally dilated pulmonary vessels, some of which were exposed to alveolar gas and, hence, participated in gas exchange.Although our observations pertain to one subject, we believe they provide the most convincing in vivo evidence to date that abnormal dilatation of interalveolar vessels may, per se, result in a significant diffusion impairment for O 2 . Furthermore, in view of the consistently negative P-M Pa,O 2 observed during oxygen breathing, we speculate that such abnormal vascular dilatation may also have produced a significant diffusive impairment of one or more of the less soluble inert gases used in the MIGET analysis. Eur Respir J., 1995Respir J., , 8, 2015Respir J., -2021

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“…The most sensitive non-invasive screening test for PAVMs, either in context of complex congenital heart disease or in patients with HHT, is contrast echocardiography [10]. Radionuclide testing using Tc99m labeled albumin microspheres is also a useful test, which can provide a quantitative measurement of the right to left shunt by measuring the fraction of the injected dose of microspheres reaching the kidneys [11]. Chest computed tomography may demonstrate PAVMs quite Page number not for citation purposes 5 accurately.…”

Section: Discussionmentioning

confidence: 99%

Congenital pulmonary arteriovenous malformation: a rare cause of cyanosis in childhood

Mottaghi¹,

Kahrom²,

Nezafati³

et al. 2010

Pan Afr Med Jrnl

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Quantification of right to left shunt through pulmonary arteriovenous malformations using 99Tcm albumin microspheres

Cited by 46 publications

References 6 publications

Cardiopulmonary Exercise Testing Demonstrates Maintenance of Exercise Capacity in Patients With Hypoxemia and Pulmonary Arteriovenous Malformations

Cardiopulmonary Exercise Testing Demonstrates Maintenance of Exercise Capacity in Patients With Hypoxemia and Pulmonary Arteriovenous Malformations

Pulmonary vascular dilatation and diffusion-dependent impairment of gas exchange in liver cirrhosis

Congenital pulmonary arteriovenous malformation: a rare cause of cyanosis in childhood

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