Clinical Significance of Pulmonary Arteriovenous Malformation Reperfusion

Pulmonary arteriovenous malformations (PAVMs) are abnormal connections of the pulmonary artery to the pulmonary vein, which bypass the normal pulmonary capillary bed.1 This leads to a right-to-left shunt the diameter of the feeding vessel. The normal pulmonary capillary bed measures only 8 to 10 mcm in diameter and serves not only to oxygenate blood but also to filter small thrombi and bacteria from passing through the pulmonary vascular bed.2 Approximately 70% of patients with PAVMs are symptomatic from their right-to-left shunt. Symptoms may be mild due to poor oxygen exchange resulting indyspneaorhypoxemia,ormoresevereasa resultof paradoxical emboli causing transient ischemic attacks (TIAs), stroke, brain abscess, systemicemboli, or septicemboli. PAVMs can also bleed spontaneously, which can cause massive lifethreatening hemoptysis.3–5 Most PAVMs are congenital with the vast majority of patients having hereditary hemorrhagic telangiectasia (HHT), otherwise known as Osler-Weber-Renu syndrome. The literature reports that the incidence of HHT in patients