HEMODYNAMICS AND GAS-EXCHANGE BEFORE AND AFTER COIL EMBOLIZATION OF PULMONARY ARTERIOVENOUS-MALFORMATIONS

A complete description of haemodynamics and gas exchange before and after percutaneous coil embolization of multiple pulmonary arteriovenous malformations is reported, in a 45 year old woman with hereditary haemorrhagic telangiectasis (HHT), Before treatment, whilst the patient complained of severe dyspnoea during daily activities, an intrapulmonary shunt of 31% was measured (inert gas elimination technique), together with a cardiac output (thermodilution technique) of 12.4 L . min(-1), resulting in a resting arterial oxygen tension (Pa,o(2)) of 8.53 kPa. Effective occlusion of all visible pulnomary malformations resulted in a rapid and major improvement in exercise tolerance, whilst resting Pa,o(2) remained almost unchanged. A second investigation performed 4 months after treatment revealed a persistent intrapulmonary shunt of 19%, a cardiac output of 7.35 L . min(-1), and a resting Pa,o(2) of 10.53 kPa. We conclude that major increases in cardiac output largely contribute to the maintenance of Pa,o(2) in patients with multiple pulmonary arteriovenous malformations and intrapulmonary shunt, The benefit of coil embolization is due both to an improvement in arterial oxygenation and a normalization of cardiac output.