A 72-year-old female patient who had a pulmonary arteriovenous malformation (PAVM) suffered systemic emboli causing pulmonary and cerebral infarction following the revision of an infected total hip replacement. Although not ultimately successful in this case, we detail the management of maintaining oxygenation and adequate cardiac output in a critically ill patient with a PAVM. We also discuss techniques that may be employed to minimise the shunt associated with the PAVM, with the aim of reducing the risk of systemic emboli.
KhurshidIDownieGH. Pulmonary arteriovenous malformation. Postgrad Med J2002;78: 191–97.
4.
KjeldsenADOxhojHAndersenPE. Prevalence of pulmonary arteriovenous malformations (PAVMs) and occurrence of neurological symptoms in patients with hereditary haemorrhagic telangiectasia (HHT). J Intern Med2000;248: 255–62.
HanSLimDJChungYG. The multiple brain abscesses associated with congenital pulmonary arteriovenous malformations: a case report. J Korean Med Sci2002;17: 407–11.
7.
ShovlinCLLetarteM. Hereditary haemorrhogic telangesctasia and pulmonary arteriovenous malformations: issues in clinical management and review of pathogenic mechanisms. Thorax1999;54: 714–29.
LoveringATElliottJEBeasleyKM. Pulmonary pathways and mechanisms regulating transpulmonary shunting into the general circulation: An update. Injury2010;41: s2: s16–s23.
12.
BosherLHBlakeAByrdBR. An analysis of the pathologic anatomy of pulmonary arteriovenous aneurysms with particular reference to the applicability of local excision. Surgery1959;45: 91–104.
13.
HoferAPuschMHaitzingerB. Successful management of severe life-threatening hypoxemia due to pulmonary arteriovenous malformation. Anesthesiology2002;97: 1313–15.
14.
SharmaDPandianMPBithalPK. Anaesthetic management of Osler-Weber-Rendu syndrome with coexisting congenital methaemoglobinaemia. Acta Anaesthesiol Scand2005;49: 1391–94.
