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Grading of Pulmonary Right-to-Left Shunt With Transthoracic Contrast Echocardiography: Does It Predict the Indication for Embolotherapy?

VAN GENT, Marco W. F ; POST, Martijn C ; SNIJDER, Repke J ; SWAANS, Martin J ; PLOKKER, Herbert W. M ; WESTERMANN, Cornelis J. J ; OVERTOOM, Tim T ; MAGER, Johannes J

Chest, 2009-05, Vol.135 (5), p.1288-1292 [Revista revisada por pares]

Northbrook, IL: American College of Chest Physicians

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Grading of Pulmonary Right-to-Left Shunt With Transthoracic Contrast Echocardiography: Does It Predict the Indication for Embolotherapy?
Autor: VAN GENT, Marco W. F ; POST, Martijn C ; SNIJDER, Repke J ; SWAANS, Martin J ; PLOKKER, Herbert W. M ; WESTERMANN, Cornelis J. J ; OVERTOOM, Tim T ; MAGER, Johannes J
Materias: Adult ; Arteriovenous Malformations - diagnostic imaging ; Arteriovenous Malformations - epidemiology ; Arteriovenous Malformations - therapy ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular system ; Comorbidity ; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava ; Coronary Circulation ; Dermatology ; Echocardiography - methods ; Embolization, Therapeutic ; Female ; Heart ; Hereditary diseases of the skin. Congenital diseases of the skin. Haemangioma of the skin, of mucosae and of soft tissue ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Pneumology ; Predictive Value of Tests ; Prospective Studies ; Pulmonary Artery - abnormalities ; Pulmonary Artery - diagnostic imaging ; Pulmonary Veins - abnormalities ; Pulmonary Veins - diagnostic imaging ; Radiography ; Telangiectasia, Hereditary Hemorrhagic - diagnostic imaging ; Telangiectasia, Hereditary Hemorrhagic - epidemiology ; Ultrasonic investigative techniques
Es parte de: Chest, 2009-05, Vol.135 (5), p.1288-1292
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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Descripción: Pulmonary arteriovenous malformations (PAVMs) are associated with severe neurologic complications in patients with hereditary hemorrhagic telangiectasia (HHT). Therefore, screening is warranted. Transthoracic contrast echocardiography (TTCE) can effectively detect a pulmonary right-to-left shunt (RLS). To determine prospectively the predictive value of TTCE grading to detect PAVMs on high-resolution CT (HRCT) scans of the chest and the indication for embolotherapy. Three hundred seventeen patients, referred for possible HHT, were screened for PAVMs. Patients who underwent both chest HRCT scanning and TTCE were included in the study (n = 281). For the purposes of this study we used a 3-point grading scale, and shunt grades 3 and 4 according to the classification model of Barzilai et al were combined. Embolotherapy was performed of all PAVMs judged large enough for treatment. Echocardiographic criteria for a pulmonary RLS were present in 105 patients (41%) [mean (+/- SD) age, 43.7 +/- 15.7 years; female gender, 63%]. Chest HRCT scan findings were positive in 55 patients (52%) in this group. The positive predictive value of shunt grade for the presence of PAVMs on chest HRCT scans was 22.9% for grade 1 (n = 35), 34.8% for grade 2 (n = 23), and 83.0% for grade 3 (n = 47), respectively. None of the patients with PAVMs seen on chest HRCT scans and a TTCE grade 1 (n = 8) or 2 (n = 8) were candidates for embolotherapy. Of 39 patients with TTCE grade 3 and PAVMs seen on chest HRCT scans, 26 patients (67%) underwent embolotherapy. An increased echocardiographic shunt grade correlates with an increased probability of PAVMs seen on chest HRCT scans. Only patients with a TTCE grade 3 displayed PAVMs on chest HRCT scans that were large enough for embolotherapy.
Editor: Northbrook, IL: American College of Chest Physicians
Idioma: Inglés

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Grading of Pulmonary Right-to-Left Shunt With Transthoracic Contrast Echocardiography: Does It Predict the Indication for Embolotherapy?

VAN GENT, Marco W. F ; POST, Martijn C ; SNIJDER, Repke J ; SWAANS, Martin J ; PLOKKER, Herbert W. M ; WESTERMANN, Cornelis J. J ; OVERTOOM, Tim T ; MAGER, Johannes J

Northbrook, IL: American College of Chest Physicians

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