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Pulmonary Arteriovenous Malformation Causing Systemic Hypoxemia in Early Infancy
V Aggarwal1, D M Khan2, J F Rhodes2
1Department of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Case Reports in Pediatrics
|April 5, 2017
Summary
Pulmonary arteriovenous malformations (AVMs) are often missed in infants. Early diagnosis and transcatheter occlusion are crucial for treating hypoxemia caused by these vascular abnormalities.
Area of Science:
- Cardiology
- Pediatric Pulmonology
- Radiology
Background:
- Pulmonary arteriovenous malformations (AVMs) are challenging to diagnose using standard echocardiography.
- Echocardiography may only suggest distal AVMs if agitated saline contrast shows late entry into left heart structures.
Observation:
- Large or complex pulmonary AVMs can cause significant right-to-left shunting and systemic hypoxemia.
- Computed tomography (CT) scans are the preferred method for direct visualization of pulmonary AVMs.
- Two infants with unexplained hypoxemia were initially managed with mechanical ventilation and ECMO before AVM diagnosis.
Findings:
- Both infants were successfully treated with transcatheter occlusion techniques in infancy.
- Mid-term follow-up showed positive outcomes after successful treatment.
Implications:
- A high index of suspicion for pulmonary AVM is vital in infants with refractory hypoxemia of unknown origin.
- Timely diagnosis and intervention, such as transcatheter occlusion, can significantly improve outcomes for affected infants.