Near-fatal haemorrhage from pulmonary arteriovenous malformation in HHT with increased cardiac output.

We read with interest the report by MONTANI et al. [1] of fatal rupture of pulmonary arteriovenous malformation (AVM) in a patient with hereditary haemorrhagic telangiectasis (HHT) and severe pulmonary arterial hypertension (PAH) confirmed by right heart catheterisation. The authors hypothesised that bleeding from pulmonary AVM may have been facilitated by increased mean pulmonary artery pressure (Ppa). Here, we report a patient with near-fatal haemorrhage from pulmonary AVM, probably facilitated by increased cardiac output, but without severe PAH.