Hereditary Telangiectasia and Multiple Pulmonary Arteriovenous Fistulas: Clinical Deterioration during Pregnancy

doi:10.1378/chest.89.3.459

Chest

Volume 89, Issue 3, March 1986, Pages 459-460

https://doi.org/10.1378/chest.89.3.459 Get rights and content

We describe the effect of pregnancy on a woman with multiple pulmonary arteriovenous fistula. Pregnancy was terminated at 35 weeks’ gestation because of severe hypoxemia. During the early postpartum period, the intrapulmonary shunt fraction enlarged, and hypoxemia worsened, necessitating emergency resection of the A-V fistula. Pregnancy may increase the intrapulmonary shunt fraction in patients with multiple pulmonary arteriovenous fistula through its effect on plasma volume and produce life-threatening hypoxemia near term or in the early postpartum period.

Section snippets

Case Report

At the age of 21, during the seventh month of pregnancy, the patient presented with symptoms of progressive fatigue, dyspnea and cyanosis. She had been an active child and at the age of 16; right lower lobe A-V fistula was discovered incidentally on a chest x-ray film. She underwent right lower lobectomy. Since her brother and father had multiple cutaneous A-V fistulas, the diagnosis of hereditary telangectasia was made. At age 19, she was hospitalized for symptoms of fatigue and

Discussion

The progression of dyspnea during pregnancy, the large shunt fraction and the severe nature of hypoxemia at the end of pregnancy indicate that the patient's shunt fraction and arterial hypoxemia must have increased significantly as her pregnancy progressed, even though objective documentation of this by serial arterial oxygen tension measurements is lacking. The most likely explanation for this increase in pulmonary arteriovenous shunting is the increase in blood volume which begins at eight

References (6)

F Hytten et al.
Clinical physiology in obstetrics
(1980)
JA Pritchard et al.
Williams Obstetrics
(1985)
JS Huseby et al.
Pulmonary arteriovenous fistulas: Increase in shunt at high lung volume
Am Rev Respir Dis
(1977)

There are more references available in the full text version of this article.

Cited by (0)

^†: Department of Medicine.

^‡: Department of Surgery, Section of Thoracic Surgery.

View full text

Chest

Selected ReportsHereditary Telangiectasia and Multiple Pulmonary Arteriovenous Fistulas: Clinical Deterioration during Pregnancy

Section snippets

Case Report

Discussion

Clinical physiology in obstetrics

Williams Obstetrics

Pulmonary arteriovenous fistulas: Increase in shunt at high lung volume

Am Rev Respir Dis

Selected Reports
Hereditary Telangiectasia and Multiple Pulmonary Arteriovenous Fistulas: Clinical Deterioration during Pregnancy