Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder characterized
by vascular malformations, and many clinical complications are related to pulmonary
arteriovenous malformations (PAVMs) because they provide direct right-to-left shunts.
Paradoxical emboli through these shunts are a well-recognized cause of transient ischemic
attack, stroke, and cerebral abscess. The aim of this study was to determine whether
paradoxical emboli through PAVMs could manifest as cardiac ischemic events. The study
included a single-center population of 98 patients with PAVMs. Eighty-four had undergone
PAVM embolotherapy, and the remaining 14 patients had PAVMs too small to require embolization.
Patients were interviewed by telephone and surveyed regarding their cardiopulmonary
symptoms and histories of cardiac diagnoses. We found that 6 patients (which is 18%
of patients with symptomatic PAVMs, n = 33, and 6% of the total cohort, n = 98) reported
that they had experienced typical angina pectoris-like chest pain or had a myocardial
infarction before PAVM embolotherapy. Five patients had had a cardiac catheterization,
4 had normal coronary arteries, and 1 had a single artery occlusion. In conclusion,
we suggest that in patients with untreated PAVMs, cardiac ischemia can occur because
of a paradoxical embolus through PAVMs to a coronary artery.
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Article Info
Publication History
Published online: May 23, 2013
Accepted:
April 11,
2013
Received in revised form:
April 11,
2013
Received:
March 5,
2013
Footnotes
See page 734 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
