Pulmonary Arteriovenous Fistulae Follow-up

  • Author: Barry A Love, MD; Chief Editor: Steven R Neish, MD, SM   more...
 
Updated: Sep 24, 2010
 

Deterrence/Prevention

See Medication for the recommended prophylactic regimen for dental, oral, sinus, and genitourinary, and GI procedures in patients with pulmonary arteriovenous malformations (PAVMs).

  • Amoxicillin 3 g orally (PO) 1 hour or 2 g intravenously (IV) 30 minutes before the procedure, followed by 1.5 g PO/IV hours after the initial dose
  • For patients who are allergic to penicillin, erythromycin 1000 mg PO 2 hours before the procedure, followed by 500 mg PO 6 hours after the initial dose
  • For patients who are allergic to penicillin, clindamycin 300 mg PO 1 hour or 300 mg IV 30 minutes before procedure, followed by 150 mg PO/IV 6 hours after initial dose

The recommended prophylactic regimen for genitourinary and GI procedures includes one of the following:

  • Amoxicillin 3 g PO 1 hour before the procedure, followed by 1.5 g PO 6 hours after the initial dose, plus gentamicin 1.5 mg/kg IV 1 hour before the procedure; this may be repeated 8 hours after the initial dose.
  • For patients who are allergic to penicillin, vancomycin 1 g IV over 1 hour plus gentamicin 1.5 mg/kg IV 1 hour before the procedure; this may be repeated 8 hours after the initial dose.
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Complications

  • Seizure
  • Migraine headaches
  • Transient ischemic attack
  • Cerebral vascular accident
  • Brain abscess
  • Hypoxemia, orthodeoxia
  • Hemothorax
  • Life-threatening hemoptysis
  • Pulmonary hypertension
  • Congestive heart failure
  • Polycythemia
  • Anemia
  • Infectious endocarditis
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Patient Education

Thoroughly educate patients with pulmonary arteriovenous malformations and patients with hereditary hemorrhagic telangiectasia (HHT) about their diagnosis and its clinical implications, complications, and hereditary nature.

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Contributor Information and Disclosures
Author

Barry A Love, MD  Assistant Professor, Department of Medicine, Division of Cardiology, Assistant Professor, Division Pediatric Cardiology, Pediatrics and Medicine, Division of Pediatric Cardiology, Mount Sinai School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Nao Sasaki  MBBS, Assistant Professor of Clinical Pediatrics, University of Miami, Leonard M. Miller School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Charles I Berul, MD  Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, and Society for Pediatric Research

Disclosure: Johnson & Johnson Consulting fee Consulting

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Alvin J Chin, MD  Professor of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician, Cardiology Division, Children's Hospital of Philadelphia

Alvin J Chin, MD, is a member of the following medical societies: American Association for the Advancement of Science, American Heart Association, and Society for Developmental Biology

Disclosure: Nothing to disclose.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM  Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine

Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association

Disclosure: Nothing to disclose.

References

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Mucosal telangiectasias are shown in a patient with hereditary hemorrhagic telangiectasia (HHT).
Left lower lobe arteriovenous malformation (AVM).
Lateral radiograph showing a left lower lobe arteriovenous malformation (AVM).
Large left lower lobe arteriovenous malformation (AVM) showing a feeding vessel to the left atrium.
Another view of the infused CT scan of the left lower lobe arteriovenous malformation (AVM).
Pulmonary angiographic findings are required not only to confirm the diagnosis but also to plan therapeutic embolization.
Small arteriovenous malformations (AVMs) in the right and left lower lobes.
Lateral radiograph shows a left lower lobe arteriovenous malformation (AVM).
Contrast-enhanced CT scan showing a left lower lobe arteriovenous malformation (AVM).
Right lower lobe arteriovenous malformation (AVM).
CT scan obtained after coil embolotherapy.
Left lower lobe embolotherapy performed at the same sitting as the coil embolotherapy depicted in the previous image.
 
 
 
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