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Two-dimensional contrast echocardiography in the detection and follow-up of congenital pulmonary arteriovenous malformations

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      Abstract

      Pulmonary arteriovenous (A-V) malformation is frequently a manifestation of Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia). We identified 14 patients (9 men and 5 women) with A-V malformation by contrast echocardiography; 10 patients with atrial right-to-left shunt served as control subjects. Agitated saline solution (10 ml) was injected through a peripheral vein during echocardiographic imaging. The delay in the appearance of microcavitations in the left atrium was measured (in number of frames) after right atrial appearance. The degree of left ventricular opacification was graded 1 to 4+ (where 4+ = intense left ventricular endocardial outline, and 1+ = minimal opacification). Results indicated patients with A-V malformation had a significant delay (p < 0.001) in left atrial appearance of microcavitations compared with those with atrial right-to-left shunt (66 ± 27 vs 21 ± 7 frames, mean ± 1 standard deviation). In the group with A-V malformation, abnormal blood gases were present in only 6 of 14 patients and chest x-ray was positive in 7. Pulmonary angiography was performed in 11 of 14 patients with positive contrast echocardiography, and all 11 had A-V malformation identified. In patients with 3 to 4+ left ventricular opacification (n = 8), large (>5 mm feeding vessel) or multiple malformations were present, whereas patients with small or isolated malformation had 1 to 2+ left ventricular opacification. Balloon occlusion of malformations was performed in all 11 of these patients; repeat contrast echocardiography revealed significant diminution of right-to-left shunt in 9, and 2 required repeat embolotherapy for an additional previously undetected A-V malformation. Thus, contrast 2-dimensional echocardiography is extremely sensitive for the identification of pulmonary A-V malformation.
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      References

        • Krowka MJ
        • Cortese DA
        Pulmonary aspects of chronic liver disease and liver transplantation.
        in: 3rd ed. Mayo Clin Proc. 60. 1988: 407-418
        • Perloff JK
        Congenital pulmonary arteriovenous fistula.
        in: The Clinical Recognition of Congenital Heart Disease. 3rd ed. WB Saunders, Philadelphia1987: 641-652
        • Dines DE
        • Seward JB
        • Bernatz PE
        Pulmonary arteriovenous fistula.
        in: Mayo Clin Proc. 58. 1983: 176-181
        • Terry RB
        • Barth KH
        • Kaufman SL
        • White RJ
        Balloon embolization for treatment of pulmonary arteriovenous fistulas.
        N Engl J Med. 1980; 302: 1189-1190
        • Hartnell GG
        • Allison DJ
        Coil embolization in the treatment of pulmonary arteriovenous malformations.
        J Thorac Imaging. 1989; 4: 81-85
        • White RI
        • Lynch-Nyhan A
        • Terry RB
        • Buescher PC
        • Farmlett EJ
        • Charnas L
        • Shuman K
        • Kim N
        • Kinnison M
        • Mitchell SE
        Pulmonary arteriovenous malformations: techniques and long term outcome of embolotherapy.
        Radiology. 1988; 169: 663-669
        • Shub C
        • Taiik AJ
        • Seward JB
        • Dines DE
        Detecting intrapulmonary right to left shunt with contrast echocardiography: observations in a patient with diffuse pulmonary arteriovenous fistulas.
        in: Mayo Clinic Proc. 51. 1976: 81-84
        • Hernandez A
        • Strauss HW
        • McKnight R
        • Hartmann Jr, AF
        Diagnosis of pulmonary arteriovenous fistula.
        J Pediatr. 1978; 93: 258-260
        • Lewis AB
        • Gates GF
        • Stanley P
        Echocardiography and perfusion scintigraphy in the diagnosis of pulmonary arteriovenous fistula.
        Chest. 1978; 73: 675-679
        • Meltzer RS
        • Vered Z
        • Roelandt J
        Systematic analysis of contrast echocardiograms.
        Am J Cardiol. 1987; 52: 375-382
        • Dinsmore BJ
        • Gefter WB
        • Hatabu H
        • Kressel HY
        Pulmonary arteriovenous malformations: diagnosis by gradient refocused MR imaging.
        J Comput Assist Tomogr. 1990; 14: 918-923