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Deng Y, Huang X, Wang G, Cao J, Wang S, Li Y, Wang Y, Ye J, Zhang P, Chen X, Luo Y, He K. Applicability of Transthoracic Contrast Echocardiography for the Diagnosis and Treatment of Idiopathic Pulmonary Arteriovenous Malformations. Front Cardiovasc Med 2021; 8:656702. [PMID: 34322523 PMCID: PMC8311437 DOI: 10.3389/fcvm.2021.656702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/21/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: To explore the preferred test to screen for pulmonary arteriovenous malformations (PAVMs) and to predict the probability of interventional embolization. Methods: We performed a retrospective observational study evaluating patients with idiopathic PAVMs from 2009 to 2019. After clinical evaluation, a total of 105 patients were studied, including 71 patients with positive digital subtraction pulmonary angiography (DSPA) findings and 34 with negative DSPA findings. The following patient data were assessed: blood test, chest radiograph, transthoracic contrast echocardiography (TTCE), and DSPA findings. Results: The majority of patients with idiopathic PAVMs were female (66.2% with positive DSPA findings). We found a good κ-coefficient of 0.77 with strong consistency for inter observer agreement concerning the pulmonary right-to-left shunt (RLS) grade on TTCE, which was superior to conventional chest radiographs. The positive predictive value (PPV) of the radiographic features for PAVMs on DSPA was 0.83 (95% CI 0.64-1.0) and 0.44 for the possibility of embolization (95% CI 0.19-0.70). The PPV of the shunt grade of PAVMs on DSPA was 0.14 (95% CI 0.01-0.29) for grade 1, 0.74 (95% CI 0.60-0.88) for grade 2, and 0.97 (95% CI 0.92-1.0) for grade 3. The PPVs of pulmonary shunt grades 2 and 3 on TTCE for the possibility of embolization for PAVMs were 0.21 (95% CI, 0.05-0.36) and 0.87 (95% CI, 0.79-0.99), respectively. Conclusion: TTCE is the preferred screening test for PAVMs. The pulmonary RLS grade on TTCE not only identifies the likelihood of PAVMs but also predicts the probability for embolization.
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Affiliation(s)
- Yujiao Deng
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Huang
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Guangyi Wang
- Department of Cardiology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Cao
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Shengshu Wang
- Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Institute of Geriatrics, Beijing, China
| | - Yue Li
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yiru Wang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | | | | | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Kunlun He
- Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
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Kim BG, Jung JH, Kim MJ, Moon EH, Oh JH, Park JW, Cha HE, Kim JH, Kim YJ, Chung JW, Hahm KB, Jin HR, Jang YJ, Kim SW, Chung SK, Kim DW, Lee YJ, Kim ST. Genetic variants and clinical phenotypes in Korean patients with hereditary hemorrhagic telangiectasia. Clin Exp Otorhinolaryngol 2021; 14:399-406. [PMID: 33677851 PMCID: PMC8606283 DOI: 10.21053/ceo.2020.02124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/25/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular disorder characterized by recurrent epistaxis, telangiectasia, and visceral arteriovenous malformations (AVMs). Activin A receptor-like type 1 (ACVRL1/ALK1) and endoglin (ENG) are the principal genes whose mutations cause HHT. No multicenter study has yet investigated correlations between genetic variations and clinical outcomes in Korean HHT patients. Methods Seventy-two members from 40 families suspected to have HHT based on symptoms were genetically screened for pathogenic variants of ACVRL1 and ENG. Patients with genetically diagnosed HHT were also evaluated. Results In the HHT genetic screening, 42 patients from 24 of the 40 families had genetic variants that met the pathogenic criteria (pathogenic very strong, pathogenic strong, pathogenic moderate, or pathogenic supporting) based on the American College of Medical Genetics and Genomics Standards and Guidelines for either ENG or ACVRL1: 26 from 12 families (50%) for ENG, and 16 from 12 families (50%) for ACVRL1. Diagnostic screening of 42 genetically positive HHT patients based on the Curaçao criteria revealed that 24 patients (57%) were classified as having definite HHT, 17 (41%) as having probable HHT, and 1 (2%) as unlikely to have HHT. Epistaxis was the most common clinical presentation (38/42, 90%), followed by visceral AVMs (24/42, 57%) and telangiectasia (21/42, 50%). Five patients (12%) did not have a family history of HHT clinical symptoms. Conclusion Only approximately half of patients with ACVRL1 or ENG genetic variants could be clinically diagnosed as having definite HHT, suggesting that genetic screening is important to confirm the diagnosis.
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Affiliation(s)
- Bo Gyeong Kim
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
| | - Joo-Hyun Jung
- Department of Otolaryngology-Head & Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Mi-Jung Kim
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
| | - Eun Hyue Moon
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea
| | - Jae-Hwan Oh
- Department of Otolaryngology-Head & Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jung-Woo Park
- Department of Otolaryngology-Head & Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Heung-Eog Cha
- Department of Otolaryngology-Head & Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Ju-Hyun Kim
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Yoon-Jae Kim
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun-Won Chung
- Department of Gastroenterology, Gachon University Gil Medical Center, Incheon, Korea
| | - Ki-Baik Hahm
- Digestive Disease Center, CHA University Bundang Medical Center, Seongnam, Korea
| | | | - Yong-Ju Jang
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Wan Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Kyung Hee University, Seoul, Korea
| | - Seung-Kyu Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Woo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jae Lee
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Korea.,Department of Biochemistry, College of Medicine, Gachon University, Incheon, Korea
| | - Seon-Tae Kim
- Department of Otolaryngology-Head & Neck Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Macaluso FS, Maida M, Alessi N, Cabibbo G, Cabibi D. Primary biliary cirrhosis and hereditary hemorrhagic telangiectasia: When two rare diseases coexist. World J Hepatol 2013; 5:288-291. [PMID: 23717740 PMCID: PMC3664287 DOI: 10.4254/wjh.v5.i5.288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/09/2013] [Accepted: 04/16/2013] [Indexed: 02/06/2023] Open
Abstract
Primary biliary cirrhosis is a slowly progressive cholestatic autoimmune liver disease that mainly affects middle-aged women with an estimated prevalence ranging from 6.7 to 402 cases per million. Hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease, is an autosomal dominant disorder characterized by angiodysplastic lesions (telangiectases and arteriovenous malformations) that can affect many organs, including liver, with a prevalence of 1-2 cases per 10000. We describe the coexistence, for the first time to our knowledge, of these two rare diseases in a 50-year old Caucasian woman. In this setting, the relevance of an accurate medical history, the role of liver histology and the characterization of liver involvement through dynamic imaging techniques can be emphasized.
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