Pulmonary arteriovenous fistula: mechanical ventilation and hypoxemia

Friedman, Bruce; McGrath, Brian J.; Williams, John F.

doi:10.1007/bf03008346

Cited by 9 publications

(7 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, his saturations were noted to deteriorate substantially when lying in the left lateral position, demonstrating a phenomenon similar to orthodeoxia with presumably increasing shunt through the pulmonary AV malformation in the dependent portion of his chest. In addition, the application of positive pressure ventilation and positive end-expiratory pressure worsened his hypoxaemia, an observation made in a previous case report of pulmonary AV malformation 10 . The mechanism of increased alveolararterial (A-a) gradient in this instance is postulated to be increased pulmonary vascular resistance resulting in further right to left shunting.…”

Section: Discussionmentioning

confidence: 56%

Pulmonary Arteriovenous Malformation Masquerading as Massive Pulmonary Thromboembolus

McGrath

2004

Anaesth Intensive Care

View full text Add to dashboard Cite

We present a case of a 78-year-old male with hereditary haemorrhagic telangiectasia and severe hypoxia incorrectly diagnosed as pulmonary embolism following a false positive ventilation/perfusion scan. Anti-coagulation and thrombolysis was complicated by an upper gastro-intestinal haemorrhage. Pulmonary arteriovenous malformations resulted in a clinically significant right-left shunt and created an apparent perfusion defect evident upon radionuclide imaging, leading to diagnostic uncertainty and a potentially dangerous treatment modality.

show abstract

Section: Discussionmentioning

confidence: 56%

Pulmonary Arteriovenous Malformation Masquerading as Massive Pulmonary Thromboembolus

McGrath

2004

Anaesth Intensive Care

View full text Add to dashboard Cite

show abstract

“…First, mucocutaneous telangiectasia in the oropharyngeal and upper respiratory regions demand careful laryngoscopy with optimal visualisation in order to avoid injury and bleeding that may complicate airway management 10. In patients with PAVMs, shunt and cardiac failure could theoretically occur during the positive pressure ventilation,10 (positive end-expiratory pressure increases pulmonary vascular resistance and reduces cardiac output),11 though this shunt risk is predominantly dependent on the size of the PAVM, rather than the process of ventilation. In our patient, with an unsecured PAVM, non-invasive cardiac output monitoring may have been useful in order to quantitatively measure the systemic effects of ventilation.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of a parturient with hereditary haemorrhagic telangiectasia (HHT) and pulmonary haemorrhage requiring urgent caesarean section

et al. 2020

View full text Add to dashboard Cite

A 25-year-old gravida 3 para 3 with a history of hereditary haemorrhagic telangiectasia (HHT) and embolised pulmonary arteriovenous malformations (PAVMs) was admitted at 36 weeks gestation with haemoptysis, epistaxis and CT evidence of recent alveolar haemorrhage. An urgent caesarean section was planned. Both previous pregnancies had been delivered by elective lower segment caesarean section (LSCS) under subarachnoid block (SAB) at term. Preanaesthetic planning involved consultation with our tertiary maternity referral centre, the national HHT centre and our tertiary adult referral centre, which has interventional radiology and cardiothoracic capabilities. A whole spine MRI was carried out to rule out vascular malformation. Following multidisciplinary discussion, the decision was made to proceed with caesarean section in our hospital under SAB. Wide bore intravenous access was sited and blood product availability was ensured in case of acute pulmonary haemorrhage. The LSCS was uneventful. Postoperatively following discharge from the hospital, the patient experienced recurrent episodes of small volume haemoptysis, and had further PAVM embolisation in the national HHT centre. This report highlights the difficulties in managing complex parturients in a non-tertiary referral centre and underlines the importance of communication and multidisciplinary team discussion to determine the most appropriate management.

show abstract

“…The partial explanation for the intra‐ and postoperative hypoxemia is the development of atelectasis or pneumonia. In addition, positive pressure ventilation during anesthesia (as well as during the treatment of laryngospasm) can worsen the right‐to‐left shunting in patients with PAVF by increasing the pulmonary vascular resistance due to the compression of the extra‐ or intra‐alveolar vessels (12). In this situation, PAVF becomes clinically significant and contributes to the hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

Unexpected ST segment changes in children – a case report

Alfirevic¹,

Mossad²,

Niezgoda³

2005

Pediatric Anesthesia

View full text Add to dashboard Cite

In children, myocardial ischemic changes during anesthesia are a rare event unless there is underlying pathology. The patient in this case report was an apparently healthy child scheduled for adenoidectomy and bilateral tympanostomy. Occurrence of significant ST changes as well as intraoperative and postoperative hypoxemia required further diagnostic work-up. Postoperative echocardiographic findings were suspicious of intrapulmonary right to left shunting. The pulmonary arteriovenous fistula is probably the major pathophysiological factor for the development of hypoxemia and paradoxical air embolism especially during positive pressure ventilation in our patient. Unexpected ST segment changes might also occur in patients with anomalous origin of coronary arteries. Although diagnostic work-up was inconclusive, it is necessary to rule out any underlying pathological process. Further follow-up is also important in order to learn more about these disease states that often have subclinical, but potentially fatal presentation.

show abstract

Pulmonary arteriovenous fistula: mechanical ventilation and hypoxemia

Cited by 9 publications

References 14 publications

Pulmonary Arteriovenous Malformation Masquerading as Massive Pulmonary Thromboembolus

Pulmonary Arteriovenous Malformation Masquerading as Massive Pulmonary Thromboembolus

Anaesthetic management of a parturient with hereditary haemorrhagic telangiectasia (HHT) and pulmonary haemorrhage requiring urgent caesarean section

Unexpected ST segment changes in children – a case report

Contact Info

Product

Resources

About