Adjuctive Procedures - Adjuctive Procedures (Thrombectomy, Atherectomy, Special Balloons)
A Case of Transcatheter Coil Embolization for Pulmonary Arteriovenous Malformation Complicated With Transient St Elevation, Heart Block and Hypotension
Lok Hang Canice Ng1, Chris Kwok Yiu Wong, Wai Chee Walter Chen1
The Heart Clinic, Hong Kong, China1,
This was a 73 years old gentleman with history of anxiety, hypertension and diabetes mellitus complained of shortness of breath since 2017.Electrocardiogram showed sinus rhythm without any ST changes. Echocardiogram showed left ventricular diastolic dysfunction. Treadmill exercise test was normal.
CT angiogram showed no significant stenosis over coronary arteries but found pulmonary arteriovenous malformation. CT pulmonary angiogram repeated in 6/2023 showed a simple type pulmonary arteriovenous malformation sized around 4.7 x 7.1 x 3.8 cm, which was supplied by single segmental branch of right lower lobar pulmonary artery. As his symptoms persisted and his oxygen saturation was always below 92% properly due to the large shunt, patient agreed for pulmonary AVM embolization.
His oxygen saturation on room air was often below 90% during pre-operation assessment. The procedure was done under monitored anesthesia case. Right femoral vein was punctured and 7 Fr shuttle sheath and 6 Fr multipurpose catheter were advanced to right pulmonary artery. The baseline pulmonary pressure and ECG were normal. Pulmonary angiogram was performed and the orifice of the AV fistula was identified. 3. selective angiogram via mic cath .mov
Current recommendations based on observational studies suggest that all PAVMs suitable for embolisation (regardless of size) should be treated, whereas the role of surgery may be limited in patients with PAVMs not suitable for embolisation. TThe rate of procedure complication is extremely low but rare serious complications such as air embolism may still occur. From the literature review, air embolism during embolisation was suspected in 4.8 % of patients. Small air emboli have a propensity to enter the coronary arteries during procedure causing acute chest pain, bradycardia, and temporary ECG changes. This usually resolves with sublingual nitroglycerin and inotrope support.