Embryology and Anatomy of Intrapulmonary Shunts

McMullan, D. Michael; Riemer, R. Kirk

doi:10.1111/echo.12888

Cited by 7 publications

(11 citation statements)

References 30 publications

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“…In addition to detection of PAVS with an increased frequency in cCVA, it appears that PAVS is “dynamic”. That is, PAVS may occur with increased severity and frequency during “hypoxic” states or during exercise . It is the presence of a previously undetected PAVS that has been noted to be a causative agent for persistent detection of a right‐to‐left shunt after device closure of a PFO …”

Section: Anatomical Associations/false Positive or Negative Pfomentioning

confidence: 99%

“…That is, PAVS may occur with increased severity and frequency during "hypoxic" states or during exercise. [44][45][46][47] It is the presence of a previously undetected PAVS that has been noted to be a causative agent for persistent detection of a right-to-left shunt after device closure of a PFO. 48 Detection of "debris" from the PVs entering the LA may result in a false positive TEE for a PAVS.…”

Section: Anatomic Al a Ssociations/fal S E P Os Itive Or Neg Ative Pfomentioning

confidence: 99%

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Identification of candidates for PFO closure in the echocardiography laboratory

et al. 2018

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A patent foramen ovale (PFO) is implicated in several pathologic processes, including that of cryptogenic stroke (cCVA). Recent trials identify “high‐risk” PFOs in patients with cCVA as likely to benefit from percutaneous closure. The younger the patient (<60 years old) the more likely a PFO may be attributable to the cCVA. The RoPE Score index helps determine the likelihood that an existing PFO is related to a cCVA. This may help guide the clinician and patient when contemplating percutaneous PFO closure. When evaluating a patient for possible percutaneous closure, one should identify the CVA as a typical ischemic type stroke. In order to “rule‐out” other causes of CVA, imaging of the intracranial arteries, cervical, and aortic arch vessels should be performed. Small vessel disease or a lacunar‐type infarct should be excluded. To rule out atrial fibrillation, prolonged monitoring should be performed. An index has been developed to determine the probability that a PFO is the causative etiology and calculates the risk of recurrence. This may help guide the clinician and patient in the decision for PFO closure. In addition, one should consider a work‐up for a hypercoagulable state. We will obtain an ultrasound of the lower extremities or consider deep pelvic vein thrombosis (prolonged sitting or malignancy). If the closure is to be performed, the Food and Drug Administration (FDA) has approved the Amplatzer PFO Occluder and the GORE Cardioform Septal Occluder for percutaneous closure. These devices are both approved in patients predominately between ages 18 and 60 years with a cCVA due to presumed paradoxical embolism as verified by a neurologist and cardiologist and when other causes of ischemic CVA have been excluded. “High‐risk” PFOs appear to achieve the most potential benefit from percutaneous closure.

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Section: Anatomical Associations/false Positive or Negative Pfomentioning

confidence: 99%

Section: Anatomic Al a Ssociations/fal S E P Os Itive Or Neg Ative Pfomentioning

confidence: 99%

Identification of candidates for PFO closure in the echocardiography laboratory

et al. 2018

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“…These may be responsible for the deviation of part of the blood from the pulmonary arteries directly into the pulmonary veins and the left chambers of the heart [12, 13]. This diverted blood reaches the systemic circulation without passing through the pulmonary capillaries, thus not undergoing the filtering function that the capillaries perform [12, 13]. This situation is characterized by non-physiologic pulmonary shunting, which may be responsible for complications due to paradoxical embolization, such as transient ischemic attack, ischemic stroke, brain abscess, or hemoptysis and hemothorax.…”

Section: Introductionmentioning

confidence: 99%

“…The latter two being secondary to intrabronchial or intrapleural rupture of the fistulas [14–16]. This type of shunt differs from the so-called physiologic pulmonary shunt, which is not associated with any clinical complications, due to the deviation of a minimal volume of blood from the bronchial arteries directly into the pulmonary veins without passing through the pulmonary capillaries, in addition to the coronary venous blood drained directly into the left ventricle [13]. …”

Section: Introductionmentioning

confidence: 99%

Pulmonary shunts in severe hepatosplenic schistosomiasis: Diagnosis by contrast echocardiography and their relationship with abdominal ultrasound findings

et al. 2017

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BackgroundSchistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt.Methodology/Principal findingsIn this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications.Conclusions/SignificanceOur findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS.

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“…As described in this “mini‐series” of review articles, opening of intrapulmonary shunts at rest, during exercise or with hypoxia may have a role in not only determining pulmonary gas exchange efficiency but have clinical relevance in cerebral embolism or decompression sickness. The paper Embryology and Anatomy of Intrapulmonary Shunts by McMullan and Riemer describes the embryology and anatomy of intrapulmonary shunts during normal growth and development, and also with several altered states, such as with the Glenn superior cavopulmonary anastomosis and with liver disease. In Clinical Consideration for Techniques to Detect and Quantify Blood Flow through Intrapulmonary Arteriovenous Anastomoses: Lessons from Physiological Studies , Duke et al .…”

mentioning

confidence: 99%