Clinical Implications of Pulmonary Shunting on Contrast Echocardiography

Cure HHT provided financial support for the publication of Dr. Sebastian Velthuis‘ thesis which focused on the diagnosis and clinical implications of pulmonary arteriovenous malformations (PAVMs) in HHT. Due to the high prevalence of PAVMs, its potential severe complications and effective treatment options, screening for PAVMs is recommended in all persons with possible or confirmed HHT. This screening was traditionally perfomred by chest CT, but has been replaced by transthroacic contrast echocardiography (TTCE). Depending on the number of contrast microbubbles counted in one still fram of the left-sided heart chamber, a pulmanry shunt is graded 1 (maximum of 29 microbubbles), 2 (30-100 microbubbles), 3 (>100 microbubbles). The aim of Dr. Velthuis’ thesis was to further investigate the clinical implications of different shunt grades on TTCE in (suspected) HHT.

Review Book in Cure HHT Resource Library

 

 

Publications Cited in Thesis Relating to HHT

  • An armored heart in constrictive pericarditis.  Journal of the American College of Cardiology, 2009;53:972
  • Atrial appendage closure for stroke prevention in patients with atrial fibrillation and Hereditary Hemorrhagic Telangiectasia. Case Reports in Cardiology, 2012; 2012:646.505
  • Hereditary Hemorrhagic Telangiectasia: how accurate are the clinical criteria? American Journal of Medical Genetis, 2013; 161(3):461-6
  • Grade of pulmonary right-to-left shunt on contrast echocardiography and cerebral complications; a striking association. Chest, 2013; 144(2):542-8
  • The role of transthoracic contrast echocardiography in the clinical diagnosis of Hereditary Haemorrhagic Telangiectasia. Chest, 2013; 144(6):1876-82
  • Predicting the size of pulmonary arteriovenous malformations on chest CT: a role for transthoracic contrast echocardiography. European Respiratory Journal, 2014; 44(1):150-159
  • Direct haemodynamic effect of pulmonary ateriovenous malformation embolisation. Netherlands Heart Journal, 2014;22)7-8):328-333
  • Pulmonary shunt fraction measurement compared to contrast echocardiography in HHT patients; time to abandon the 100% oxygen method?  Respiration, 2014, in press
  • Clinical implications of pulmonary shunting on contrast echocardiography. Journal of American Society of Echocardiography, 2014, under revision
  • Percutaneous closure of the left atrial appendage in patients with atrial fibrillation and hereditary haemorrhagic telangiectasia; a new strategy to prevent strokes without excessive bleeding risk? Cardiovascular Diagnosis & Therapy, 2015
  • Pulmonary hypertension in hereditary haemorrhagic telangiectasia. World Journal of Cardiology, 2015