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Postembolotherapy Pulmonary Arteriovenous Malformation Follow-Up: A Role for Graded Transthoracic Contrast Echocardiography Prior to High-Resolution Chest CT Scan.

Authors
  • DePietro, Daniel M1
  • Curnes, Nicole R2
  • Chittams, Jesse3
  • Ferrari, Victor A4
  • Pyeritz, Reed E5
  • Trerotola, Scott O6
  • 1 Department of Radiology, Division of Interventional Radiology, University of Pennsylvania, Philadelphia, PA.
  • 2 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  • 3 Biostatistics Consulting, Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, PA.
  • 4 Department of Medicine, Cardiovascular Division and Penn HHT Center of Excellence, Philadelphia, PA.
  • 5 Department of Medicine, Division of Medical Genetics and Penn HHT Center of Excellence, Philadelphia, PA.
  • 6 Department of Radiology, Division of Interventional Radiology and Penn HHT Center of Excellence, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: [email protected]
Type
Published Article
Journal
CHEST Journal
Publisher
Elsevier
Publication Date
Nov 30, 2019
Identifiers
DOI: 10.1016/j.chest.2019.11.023
PMID: 31794700
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

High-resolution chest CT (HRCT) scan is recommended after pulmonary arteriovenous malformation (PAVM) embolotherapy to assess for PAVM persistence and untreated PAVM growth. Graded transthoracic contrast echocardiography (TTCE) predicts the need for embolotherapy in PAVM screening. This study sought to determine whether postembolotherapy graded TTCE can similarly predict the need for repeat embolotherapy. Thirty-two patients (8 men and 24 women; mean age, 51.1 ± 12.6 years) with prior PAVM embolotherapy and follow-up HRCT scan were prospectively enrolled. Patients underwent graded TTCE using a validated three-point quantitative grading scale. TTCE grade and HRCT findings were compared. Median time between most recent HRCT scan and TTCE was 7 days (interquartile range, 0-272 days). Thirty patients (94%) had no PAVMs requiring repeat embolotherapy on HRCT scan. Two patients (6%) had PAVMs requiring repeat embolotherapy (feeding artery [FA] ≥ 3 mm), one with untreated PAVM growth and one with treated PAVM persistence. TTCE was positive in 88% of patients (n = 28). All patients (n = 4, 12%) with negative TTCE had no visible PAVMs on HRCT scan. Nine patients (32%) had grade 1 shunt, 10 (35%) had grade 2 shunt, and nine (32%) had grade 3 shunt. No patients with grade 1 shunt had PAVMs amenable to repeat embolotherapy on HRCT scan. All patients (n = 2) with PAVMs requiring repeat embolotherapy (FA ≥ 3 mm) had grade 3 shunt. TTCE grade was significantly associated with PAVM FA diameter (P < .001). Postembolotherapy graded TTCE can predict the need for repeat embolotherapy on HRCT scan. Patients with negative TTCE and grade 1 shunt may not require HRCT follow-up and can potentially be followed with serial graded TTCE. ClinicalTrials.gov; No.: NCT02936349; URL: www.clinicaltrials.gov. Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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