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Asai Y, Saito K, Ohta-Ogo K, Hatakeyama K, Sakurai E, Akamatsu H, Suzuki D, Kojima A, Uchida H, Nakajima Y, Hata T, Hoshikawa Y, Yoshikawa T. A novel SMAD9 nonsense variant in an 11-year-old Japanese patient with diffuse pulmonary arteriovenous malformation: A case report. J Cardiol Cases 2025; 31:80-83. [PMID: 40270704 PMCID: PMC12013742 DOI: 10.1016/j.jccase.2024.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 11/20/2024] [Accepted: 11/26/2024] [Indexed: 04/25/2025] Open
Abstract
Most cases of pulmonary arteriovenous malformation (PAVM) are associated with hereditary hemorrhagic telangiectasia (HHT). HHT is typically caused by loss-of-function gene mutations in the genes ENG, ACVRL1, or SMAD4, all participating in transforming growth factor β (TGF-β) family signaling pathways. We describe the case of an 11-year-old Japanese girl with PAVM, with no known family history of HHT or similar disease. She was found to carry a novel nonsense variant in SMAD9 (SMAD9-p. T267*), which we speculate contributed to her disease, because SMAD9 also participates in TGF-β family signaling pathways. SMAD9 mutations have been linked with pulmonary arterial hypertension (PAH), and, hence, mutations in SMAD9-as for ENG, ACVRL1, and SMAD4-may predispose to both PAH and HHT(-characteristic) disease features. The PAVM in our patient spread diffusely inside the lower lobe of the left lung, and coil embolization was considered difficult. Therefore, after feasibility assessment by performing a balloon occlusion test during cardiac catheterization, left lower lobectomy was performed. The patient's dyspnea recovered well postoperatively, and two years later an increase in left lung volume was observed and disease symptoms had not recurred. Thus, if PAVM spreads diffusely in a certain lung area, surgical treatment can be a viable option. Learning objective SMAD9 gene mutations have been linked to pulmonary arterial hypertension (PAH). However, their associations with hereditary hemorrhagic telangiectasia (HHT) or pulmonary arteriovenous malformation (PAVM), which usually is HHT-associated, have not been reported previously. Our PAVM patient carrying a SMAD9 variant suggests that mutations in this gene, like in others participating in TGF-β family signaling pathways (like ENG, ACVRL1, and SMAD4), predispose to both PAH and HHT(-characteristic) disease features. Diffuse PAVM confined to a lung area may be treated by lobectomy.
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Affiliation(s)
- Yumiko Asai
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kazuyoshi Saito
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kinta Hatakeyama
- Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Eiko Sakurai
- Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hokuto Akamatsu
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Daijiro Suzuki
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Arisa Kojima
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hidetoshi Uchida
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yoichi Nakajima
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Tadayoshi Hata
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yasushi Hoshikawa
- Department of Respiratory Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Japan
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Griffo R, Klotz LV, Brendel L, Rösch R, Niedermaier B, Schlamp K, Kriegsmann M, Eichhorn MM, Winter H. Pulmonary arteriovenous malformation causing lung sequestration and media infarction: a case report. Front Med (Lausanne) 2025; 12:1490820. [PMID: 40007589 PMCID: PMC11850261 DOI: 10.3389/fmed.2025.1490820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 01/20/2025] [Indexed: 02/27/2025] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) are rare vascular malformations of the lungs. Direct communication of pulmonary arteries to pulmonary veins is the defining characteristic allowing venous blood to bypass the pulmonary capillary system and avoiding an efficient oxygenation process. The complexity of the pathology lies not only in the variety of its manifestations, but also in the choice of the most appropriate and effective treatment. We present a case of a complex PAVM associated with a persistent foramen ovale, with stroke as the onset symptom. Despite timely multidisciplinary treatment of the malformation, a potentially fatal pulmonary complication occurred, highlighting the critical importance of early, interdisciplinary management and ongoing follow-up of PAVMs, particularly in preventing life-threatening outcomes.
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Affiliation(s)
- Raffaella Griffo
- Thoraxklinik, Department of Thoracic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Laura V. Klotz
- Thoraxklinik, Department of Thoracic Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), Heidelberg, Germany
| | - Lena Brendel
- Thoraxklinik, Department of Thoracic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Romina Rösch
- Thoraxklinik, Department of Thoracic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Niedermaier
- Thoraxklinik, Department of Thoracic Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Kai Schlamp
- Thoraxklinik, Department of Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mark Kriegsmann
- Translational Lung Research Center (TLRC), Heidelberg, Germany
- Thoraxklinik, Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin M. Eichhorn
- Thoraxklinik, Department of Thoracic Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), Heidelberg, Germany
| | - Hauke Winter
- Thoraxklinik, Department of Thoracic Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center (TLRC), Heidelberg, Germany
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Lu W, Dai H, Li Y, Meng X. Neurological and cardiopulmonary manifestations of pulmonary arteriovenous malformations. Front Med (Lausanne) 2024; 11:1449496. [PMID: 39364022 PMCID: PMC11446853 DOI: 10.3389/fmed.2024.1449496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 09/06/2024] [Indexed: 10/05/2024] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) are direct pulmonary artery-to-vein connections without pulmonary capillaries that result in intrapulmonary right-to-left blood shunts. Although most patients with PAVMs may be entirely asymptomatic, PAVMs can induce a series of complications involving the neurological, cardiovascular, and respiratory systems that can lead to catastrophic and often fatal clinical sequelae. In this study we review the available literature and summarize the reported PAVM-related complications among patients with PAVMs. The reviewed studies included observational studies, case studies, prospective studies, and cohort studies, and we provide an overview of PAVM-related neurological and cardiopulmonary manifestations, including stroke, cerebral abscess, transient ischemic attack, cerebral hemorrhage, migraine, seizure, dizziness, cardiac failure, arrhythmia, myocardial infarction, cough, hypoxemia, dyspnea, respiratory failure, hemoptysis, and hemothorax. Identifying and treating PAVMs before the presentation of major complication is important because this can prevent the occurrence of complications and can result in better outcomes. PAVM patients should thus be better evaluated and managed by a multidisciplinary team because they may be in a treatable phase prior to their condition becoming life-threatening.
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Affiliation(s)
- Weida Lu
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Honggang Dai
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Yunyi Li
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao Meng
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
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Luo K, Chen K, Li Y, Ji Y. Clinical evaluation of laryngeal mask airways in video-assisted thoracic surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Surg 2024; 19:361. [PMID: 38915035 PMCID: PMC11194903 DOI: 10.1186/s13019-024-02840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Endotracheal intubation is often associated with postoperative complications such as sore throat discomfort and hoarseness, reducing patient satisfaction and prolonging hospital stays. Laryngeal mask airway (LMA) plays a critical role in reducing airway complications related to endotracheal intubation. This meta-analysis was performed to determine the efficacy and safety of LMA in video-assisted thoracic surgery (VATS). METHODS The PubMed, Embase, Cochrane Library, Medline and Web of Science databases were searched for eligible studies from inception until October 5, 2023. Cochrane's tool (RoB 2) was used to evaluate the possibility biases of RCTs. We performed sensitivity analysis and subgroup analysis to assess the robustness of the results. RESULTS Seven articles were included in this meta-analysis. Compared with endotracheal intubation, there was no significant difference in the postoperative hospital stay (SMD = -0.47, 95% CI = -0.98-0.03, P = 0.06), intraoperative minimum SpO2 (SMD = 0.00, 95% CI = -0.49-0.49, P = 1.00), hypoxemia (RR = 1.00, 95% CI = 0.26-3.89, P = 1.00), intraoperative highest PetCO2 (SMD = 0.51, 95% CI = -0.12-1.15, P = 0.11), surgical field satisfaction (RR = 1.01, 95% CI = 0.98-1.03, P = 0.61), anesthesia time (SMD = -0.10, 95% CI = -0.30-0.10, P = 0.31), operation time (SMD = 0.06, 95% CI = -0.13-0.24, P = 0.55) and blood loss (SMD =- 0.13, 95% CI = -0.33-0.07, P = 0.21) in LMA group. However, LMA was associated with a lower incidence of throat discomfort (RR = 0.28, 95% CI = 0.17-0.48, P < 0.00001) and postoperative hoarseness (RR = 0.36, 95% CI = 0.16-0.81, P = 0.01), endotracheal intubation was found in connection with a longer postoperative awake time (SMD = -2.19, 95% CI = -3.49 - -0.89, P = 0.001). CONCLUSION Compared with endotracheal intubation, LMA can effectively reduce the incidence of throat discomfort and hoarseness post-VATS, and can accelerate the recovery from anesthesia. LMA appears to be an alternative to endotracheal intubation for some specific thoracic surgical procedures, and the efficacy and safety of LMA in VATS need to be further explored in the future.
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Affiliation(s)
- Kai Luo
- Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Kaiming Chen
- Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yu Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Ji
- Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Han T, Gao J, Wang Z, Zhou J. Case report: video-assisted thoracoscopic surgery for pulmonary arteriovenous malformation using near-infrared fluorescence with indocyanine green. J Cardiothorac Surg 2023; 18:301. [PMID: 37891653 PMCID: PMC10612221 DOI: 10.1186/s13019-023-02351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between pulmonary vasculatures and has an unclear boundary with surrounding lung tissues. At present, surgeons can only determine its location by preoperative imaging and intraoperative palpation, despite its soft texture. Indocyanine green(ICG), a near-infrared fluorophore, has been demonstrated useful in the accurate identification of vascular tissue. Therefore, we explored its application in PAVM cases. CASE PRESENTATION We present two PAVM cases using near-infrared fluorescence (NIF) with 25 mg ICG at 5 mg/ml to achieve intraoperative visualization of the lesion in video-assisted thoracoscopic surgery (VATS). Under the NIF mode, ICG systemic injection led to successive signaling of the anomaly and normal tissues in merely 10 s, which helped us distinguish them efficiently and precisely. A peak signal-to-background ratio of 2.2 confirmed the significant fluorescence difference and excluded interference from carbon dust. CONCLUSIONS We are the first to report the use of such an approach in delineating the margin of vascular malformation with high contrast, and this new finding may help minimize the damage to lung function in PAVM treatment. Further exploration and validation are needed to determine its role.
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Affiliation(s)
- Tianxiao Han
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Jian Gao
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Zhenfan Wang
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Jian Zhou
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China.
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Fekadu D, Kassa S, Mamo S, Tadesse I, Gebeyehu H. Pulmonary arteriovenous malformation: Challenging diagnosis: A case report. Radiol Case Rep 2023; 18:3777-3780. [PMID: 37664161 PMCID: PMC10468361 DOI: 10.1016/j.radcr.2023.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 09/05/2023] Open
Abstract
Pulmonary arteriovenous malformation is characterized by an anatomic right-to-left shunt between the pulmonary arteries and veins, is characterized by an anatomic right-to-left shunt which reduces the arterial oxygen saturation and then results in clinical manifestations such as dyspnea and cyanosis. Most cases are congenital, and although uncommon, they are a significant part of the differential diagnosis of pulmonary problems like hypoxemia and lung nodules. We present a case of a 60 years old female patient who presented with the complaint of exacerbation of dry cough of 1-month duration and was diagnosed with right pulmonary arteriovenous malformation and successfully treated with surgery.
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Affiliation(s)
- Desalegn Fekadu
- Department of Surgery, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seyoum Kassa
- Department of Surgery, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Siyasibew Mamo
- Department of Surgery, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Israel Tadesse
- Department of Surgery, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hiwot Gebeyehu
- Department of Surgery, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Irie T, Ishibashi O, Kuramochi M, Ichimura H, Endo K. Retrospective single-arm cohort study of video-assisted thoracic surgery for treatment of idiopathic peripherally located simple type pulmonary arteriovenous malformation in 23 consecutive patients. J Cardiothorac Surg 2023; 18:213. [PMID: 37403112 DOI: 10.1186/s13019-023-02335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Although case reports of video-assisted thoracic surgery (VATS) for pulmonary arteriovenous malformation (PAVM) have been published, studies analyzing more than 10 cases were limited. A retrospective single-arm cohort study was performed to investigate the efficacy of VATS in 23 consecutive patients with idiopathic peripherally located simple type PAVM. METHODS VATS was performed for wedge resection of 24 PAVMs in 23 patients, which included 4 males and 19 females with an age range of 25 to 80 years (mean: 59.6 ± 13.0). Two patients underwent simultaneous resection of lung carcinoma, one by wedge resection and another by lobectomy. Each medical record was analyzed according to the resected specimen, bleeding volume, postsurgical hospital stay length, duration of chest tube placement, and VATS time. The distance between pleural surface/fissure and PAVM was measured on CT, and the influence of this distance on identification of PAVM was investigated. RESULTS In all 23 patients, VATS was successfully performed, and the venous sac was included in each resected specimen. Bleeding volume was less than 10mL in all but one with 1900 mL bleeding volume due to simultaneous lobectomy for carcinoma, not wedge resection of PAVM. Postsurgical hospital stay length, duration of chest tube placement, and VATS time were 5.0 ± 1.4 days, 2.7 ± 0.7 days, and 49.3 ± 39.9 min, respectively. In 21 PAVMs with a distance of 1 mm or less, purple vessel or pleural bulge of PAVM was identified soon after insertion of a thoracoscope. In the remaining 3 PAVMs with a distance of 2.5 mm or more, additional efforts were needed for identification. CONCLUSION VATS was found to be a safe and effective to treatment for idiopathic peripherally located simple type PAVM. When the distance between pleural surface/fissure and PAVM was 2.5 mm or more, a plan and strategy for identification of PAVM should be prepared before VATS.
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Affiliation(s)
- Toshiyuki Irie
- Department of Radiology, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Miyamachi 3-2-7, Mito City, 310-0015, Ibaraki prefecture, Japan.
| | - Osamu Ishibashi
- Department of Thoracic Surgery, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito City, Japan
| | - Masashi Kuramochi
- Department of Radiology, Hitachi General Hospital, Hitachi City, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi City, Japan
| | - Katsuyuki Endo
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi City, Japan
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Matsudo K, Haratake N, Ono Y, Kohno M, Takenaka T, Yoshizumi T. Multiple systemic artery to pulmonary vessel fistulas (SAPVFs) completely resected by video-assisted thoracoscopic surgery: a case report. Surg Case Rep 2022; 8:184. [PMID: 36167860 PMCID: PMC9515267 DOI: 10.1186/s40792-022-01540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Systemic artery to pulmonary vessel fistula (SAPVF) is an uncommon abnormal vascular communication between systemic arteries and the lung parenchyma. It has been reported that the appropriate treatment for SAPVF is embolization or surgical resection. However, in patients such as ours, who have many aberrant vessels or multiple lesions, surgery should be considered as the first-choice treatment. Case presentation This case report describes multiple SAPVFs and huge bullae at the apex of the left lung in a 43-year-old man that were resected completely with the video-assisted thoracoscopic surgery (VATS). The patient had an uneventful postoperative recovery without any complications and was discharged 9 days postoperatively. He had heavy smoking history, and the giant bullae and the diffuse emphysematous change were found in the lung. Therefore, the chronic inflammation may have been present in the thoracic cavity, which caused multiple SAPVFs. Conclusions We describe the clinical course and management of the patient with multiple SAPVFs who had no obvious history of surgery, trauma, or various inflammatory or infection diseases. VATS should be the first-choice treatment in patients with many abnormal vessels or multiple lesions.
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Pulmonary arteriovenous malformation and inherent complications with solitary lung nodule biopsy—literature overview and case report. Radiol Case Rep 2022; 17:2353-2361. [PMID: 35570867 PMCID: PMC9096463 DOI: 10.1016/j.radcr.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
Pulmonary arteriovenous malformation, also known as an arteriovenous fistula, is typically a congenital disease caused by structural deficiencies, particularly the lack of capillary wall development, leading to the abnormal dilation of the pulmonary capillaries. The majority of pulmonary arteriovenous malformation cases are associated with Rendu–Osler–Weber syndrome, also known as hereditary hemorrhagic telangiectasia. Pulmonary arteriovenous malformation rarely occurs due to chest trauma. Pulmonary arteriovenous malformations are long-lasting and often first diagnosed in adults. More than two-thirds of pulmonary arteriovenous malformation lesions are found in the lower lung lobe and the subpleural area, and the vast majority of cases present with the monofocal form. The initial diagnosis is often based on the identification of a solitary pulmonary nodule. However, a solitary nodule detected on chest computed tomography that is not correctly diagnosed as pulmonary arteriovenous malformation, even after intravenous contrast injection, can lead to the performance of a transthoracic biopsy. Biopsy of pulmonary arteriovenous malformations can lead to stroke occurrence, during which the patient often presents with severe pleural bleeding, which can have lifelong consequences if not immediately treated. We report a case of pulmonary arteriovenous malformation that was discovered incidentally in an adult patient who underwent non-contrast computed tomography. Misdiagnosis occurred, and transthoracic lung biopsy was performed. Complications were discovered late, and the patient underwent surgical pulmonary arteriovenous malformation removal and was treated for hemothorax.
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Bouassida I, Hamdi B, Abdelkbir A, Zribi H, Neji H, Ouerghi S, Hamzaoui A, Marghli A. [A case of pulmonary arteriovenous malformation treated surgically]. Rev Mal Respir 2021; 38:1037-1041. [PMID: 34794845 DOI: 10.1016/j.rmr.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 06/23/2021] [Indexed: 10/19/2022]
Abstract
Pulmonary arteriovenous malformation is a rare abnormality consisting of a direct connection between the arteries and the pulmonary veins. Most of the malformations are related to hereditary hemorrhagic telangiectasia, although 10 to 20% cases are idiopathic. Clinical manifestations are due to right-to-left shunting. Embolization is the treatment of choice, when it is possible and accessible. Surgery continues to be appropriate in certain cases. We report the case of a woman who presented with an isolated complex arteriovenous malformation fed by two afferent arteries, a lingular one and an antero-basal one. Surgical treatment by lingual and antero-basal bisegmentectomy was undertaken with a good outcome.
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Affiliation(s)
- I Bouassida
- Service de chirurgie thoracique et cardiovasculaire, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - B Hamdi
- Service de pneumologie Pav B, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - A Abdelkbir
- Service de chirurgie thoracique et cardiovasculaire, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie.
| | - H Zribi
- Service de chirurgie thoracique et cardiovasculaire, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - H Neji
- Service de radiologie, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - S Ouerghi
- Service d'anesthésie réanimation, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - A Hamzaoui
- Service de pneumologie Pav B, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie
| | - A Marghli
- Service de chirurgie thoracique et cardiovasculaire, université Tunis el Manar, hôpital Abderrahmen Mami, Ariana, Tunisie
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Yu MG, Jing R, Mo YJ, Lin F, Du XK, Ge WY, Dai HJ, Hu ZK, Zhang SS, Pan LH. Non-intubated anesthesia in patients undergoing video-assisted thoracoscopic surgery: A systematic review and meta-analysis. PLoS One 2019; 14:e0224737. [PMID: 31714904 PMCID: PMC6850529 DOI: 10.1371/journal.pone.0224737] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Non-intubated anesthesia (NIA) has been proposed for video-assisted thoracoscopic surgery (VATS), although how the benefit-to-risk of NIA compares to that of intubated general anesthesia (IGA) for certain types of patients remains unclear. Therefore, the aim of the present meta-analysis was to understand whether NIA or IGA may be more beneficial for patients undergoing VATS. METHODS A systematic search of Cochrane Library, Pubmed and Embase databases from 1968 to April 2019 was performed using predefined criteria. Studies comparing the effects of NIA or IGA for adult VATS patients were considered. The primary outcome measure was hospital stay. Pooled data were meta-analyzed using a random-effects model to determine the standard mean difference (SMD) with 95% confidence intervals (CI). RESULTS AND DISCUSSION Twenty-eight studies with 2929 patients were included. The median age of participants was 56.8 years (range 21.9-76.4) and 1802 (61.5%) were male. Compared to IGA, NIA was associated with shorter hospital stay (SMD -0.57 days, 95%CI -0.78 to -0.36), lower estimated cost for hospitalization (SMD -2.83 US, 95% CI -4.33 to -1.34), shorter chest tube duration (SMD -0.32 days, 95% CI -0.47 to -0.17), and shorter postoperative fasting time (SMD, -2.76 days; 95% CI -2.98 to -2.54). NIA patients showed higher levels of total lymphocytes and natural killer cells and higher T helper/T suppressor cell ratio, but lower levels of interleukin (IL)-6, IL-8 and C-reactive protein (CRP). Moreover, NIA patients showed lower levels of fibrinogen, cortisol, procalcitonin and epinephrine. CONCLUSIONS NIA enhances the recovery from VATS through attenuation of stress and inflammatory responses and stimulation of cellular immune function.
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Affiliation(s)
- Mei-gang Yu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Ren Jing
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yi-jie Mo
- Department of Anesthesiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Fei Lin
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue-ke Du
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wan-yun Ge
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hui-jun Dai
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhao-kun Hu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Sui-sui Zhang
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ling-hui Pan
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- The Laboratory of Perioperative Medicine Research Center, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * E-mail:
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Abdullah I. The blue–red divide: What approach? J Thorac Cardiovasc Surg 2018; 156:e127. [DOI: 10.1016/j.jtcvs.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 11/27/2022]
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Fan C, Cheng J, Wu S, Tang S, Chen W, Yang J. Pulmonary Arteriovenous Malformation Detected by Three-dimensional Computed Tomographic Angiography. Heart Lung Circ 2017; 26:e59-e61. [PMID: 28400192 DOI: 10.1016/j.hlc.2017.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 12/23/2016] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Chengming Fan
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Cheng
- Department of the Cardiothoracic Surgery, Xiangtan Center Hospital, Xiangtan, China
| | - Sijie Wu
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shiyuan Tang
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Chen
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinfu Yang
- Department of the Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
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Fetisov NI, Maskin SS. Arteriovenous anomalies of lung vessels: pathomorphology, diagnostics, surgical treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.24884/0042-4625-2017-176-3-102-107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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