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J Thorac Cardiovasc Surg 2005;130:1456-1458
© 2005 The American Association for Thoracic Surgery

Brief Communication

Surgical treatment of recurrent transient ischemic attacks and hemoptysis in a young man with multiple pulmonary arteriovenous malformations

Cliff K. Choong, FRACS a , Daniel M. Goodenberger, MD b , c , Daniel Picus, MD b , d , Bryan F. Meyers, MD a , *

a Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.
b Washington University Hereditary Hemorrhagic Telangiectasia Center, Washington University School of Medicine, St Louis, Mo.
c Department of Medicine, Washington University School of Medicine, St Louis, Mo.
d Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo.

Received for publication March 3, 2005; revisions received June 3, 2005; accepted for publication June 7, 2005.

* Address for reprints: Bryan F. Meyers, MD, Associate Professor of Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110. (Email: meyersb@msnotes.wustl.edu).

The first 20% of the full text of this article appears below.


Figure 1
Drs Meyers and Choong


Pulmonary arteriovenous malformation (PAVM) is a rare vascular anomaly with an incidence of 2 to 3 per 100,000 population. 1 Go We present a patient whose therapy with embolotherapy for PAVMs resulted in recurrent transient ischemic attacks (TIAs) and massive hemoptysis requiring treatment by surgical resection.

Clinical Summary

A 17-year-old man with hereditary hemorrhagic telangiectasia (HHT) had PAVMs incidentally discovered on a chest x-ray film. Investigations confirmed PAVMs without the presence of associated bronchial collateral artery. Although his pulse oxygen saturation at rest was 80%, he was asymptomatic. He underwent embolization therapy with aneurysmal coil placement and cyanoacrylate glue elsewhere (Figures 1A and 1B). Go One week later, he had the first of recurrent TIAs with tingling and numbness in the right upper extremity. Investigations including carotid duplex scan, echocardiography, and cerebral CT and MRI did not reveal any abnormalities. The TIAs were considered to be most likely caused by emboli originating from clot propagation distal to the coils. Six months later, he had the first of multiple episodes of hemoptysis of 16 ounces or more, which were unresponsive to embolotherapy of several smaller PAVMs. Angiography at our center showed occlusion of the majority of the PAVMs. A . . . [Full Text of this Article]






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