AI Article Synopsis
- Pulmonary arteriovenous malformations (PAVM) are abnormal connections between arteries and veins that can lead to complications, and embolization is effective in treating them but is typically avoided in patients with pulmonary hypertension (PH).
- A case study of a 70-year-old patient with both a large PAVM and mild PH due to COPD showed that embolization led to improved breathing and gas exchange without worsening the PH.
- The findings suggest that careful hemodynamic assessment can allow for embolization in stable PH patients, using shunt flow and post-embolization pulmonary vascular resistance as critical factors in the decision-making process.
Article Abstract
Introduction: Pulmonary arteriovenous malformations (PAVM) are abnormal communications between arteries and pulmonary veins without interposition of capillaries. Embolization is effective both in reducing lifetime complications associated with PAVM and in improving arterial oxygenation. Embolization is however not recommended in patients with pulmonary hypertension (PH) as it abolishes low resistance pathways for pulmonary blood flow and therefore might be expected to elevate pulmonary arterial pressure (PAP).
Case Report: We report the case of a 70-year-old patient with a large PAVM as well as group 3 PH [mean PAP=21mmHg, pulmonary vascular resistance (PVR) at 3.4 Wood units] secondary to stage 2 chronic obstructive pulmonary disease (COPD) with emphysema. According to the measured shunt flow (26% of cardiac output), predicted post-embolization PVR was estimated at 4.6 Wood units. These values were considered compatible with embolization of the PAVM. Dyspnea and gas exchange improved after PAVM embolization, without worsening PH.
Conclusion: Embolization of a PAVM can be considered in patients with stable PH but requires careful prior hemodynamic assessment. The estimation of the shunt flow and predicted post-embolization PVR may guide the therapeutic decision.
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| http://dx.doi.org/10.1016/j.rmr.2020.06.012 | DOI Listing |
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