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Filbrich M, Brisbois D, Lebrun Y, Godin PA, Verscheure S. Spontaneous haemothorax caused by a ruptured pulmonary arterio-venous malformation: A manifestation of hereditary haemorrhagic telangiectasia in pregnancy. Obstet Med 2024; 17:112-115. [PMID: 38784192 PMCID: PMC11110747 DOI: 10.1177/1753495x221145809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/25/2022] [Accepted: 11/21/2022] [Indexed: 05/25/2024] Open
Abstract
We report our experience of managing a massive haemothorax caused by a ruptured, previously unknown, pulmonary arteriovenous malformation (pAVM) at 34 + 5 weeks of gestation, which proved to be a manifestation of hereditary haemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome. The patient underwent an emergency caesarean section under general anaesthesia after placement of a chest tube and gave birth to a healthy infant. A postoperative thoracic computed tomography angiography highlighted the presence of the large pAVM. Transcatheter embolization was performed right after the delivery. Subsequent patient's anamnesis, family history and genetic analysis finally revealed the presence of the syndrome. The aim of our report is to create awareness of this serious condition with potential life-threatening complications, especially in pregnancy. Simple criteria have been published and allow to easily consider HHT and the presence of potential AVM during anamnesis, ideally even before pregnancy.
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Affiliation(s)
- Maike Filbrich
- Cliniques Universitaires Saint Luc, Bruxelles, Belgium
- Clinique MontLégia CHC, Liege, Belgium
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Delagrange L, Dupuis O, Fargeton AE, Bernard L, Decullier E, Dupuis-Girod S. Obstetrical and neonatal complications in hereditary haemorrhagic telangiectasia: A retrospective study. BJOG 2023; 130:303-311. [PMID: 36156839 PMCID: PMC10092409 DOI: 10.1111/1471-0528.17303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To retrospectively describe a large series of pregnancies in women with hereditary haemorrhagic telangiectasia followed in our reference centre, plus neonatal outcomes, to better understand the risks of complications and to improve their prevention. DESIGN A retrospective descriptive study conducted through a phone questionnaire. SETTING Reference centre for hereditary haemorrhagic telangiectasia in Lyon, France. POPULATION Women meeting the following criteria: (1) alive and aged ≥18 years; (2) with a definite clinical and/or genetic diagnosis of hereditary haemorrhagic telangiectasia; and (3) with at least one full-term pregnancy. MAIN OUTCOME MEASURES Maternal and perinatal outcomes of pregnancies in women with hereditary haemorrhagic telangiectasia. RESULTS Five hundred and sixty-two pregnancies were reported in 207 women with hereditary haemorrhagic telangiectasia. A total of 271 complications (48.2%) were registered. Of these, 149 (55%) non-specific complications, 110 (40.6%) non-severe specific complications and 12 (4.4%) severe specific complications were registered. There were four cases of haemoptysis and two cases of transient ischaemic attack related to pulmonary arteriovenous malformations. Four patients had severe decompensated dyspnoea, related to pulmonary arteriovenous malformations in three cases and to pulmonary arteriovenous malformations associated with severe hepatic arteriovenous malformations in one case. Hepatobiliary necrosis occurred in one case. Epidural or spinal anaesthesia was performed in 139 of 452 deliveries (31%), without complications. There were 12 reports of congenital anomalies in 461 live births (3%). CONCLUSIONS Most pregnancies in hereditary haemorrhagic telangiectasia women are uneventful; complications are rare but can be severe. Women thus need to be educated about screening and possible pregnancy-related risks before becoming pregnant.
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Affiliation(s)
- Laura Delagrange
- Hospices Civils de Lyon, Centre de référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | - Olivier Dupuis
- Hospices Civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Lyon-Sud, Pierre-Bénite, France.,Faculté de Médecine, Université de Lyon, Lyon, France
| | - Anne-Emmanuelle Fargeton
- Hospices Civils de Lyon, Centre de référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France
| | - Lorraine Bernard
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.,Université Lyon 1, Lyon, France
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle de Santé Publique, Lyon, France.,Université Lyon 1, Lyon, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Centre de référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfant, Bron, France.,Université Grenoble Alpes, INSERM, CEA, BIG-Biologie du Cancer et de l'Infection, Grenoble, France
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Dupuis O, Delagrange L, Dupuis-Girod S. Hereditary haemorrhagic telangiectasia and pregnancy: a review of the literature. Orphanet J Rare Dis 2020; 15:5. [PMID: 31910869 PMCID: PMC6947864 DOI: 10.1186/s13023-019-1286-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background Hereditary haemorrhagic telangiectasia (HHT) is a dominantly inherited genetic vascular disorder that has prevalence of 1:5000 to 1:8000, and which is characterised by recurrent epistaxis, cutaneous telangiectasia, and arteriovenous malformations (AVMs) that affect many organs including the lungs, gastrointestinal tract, liver, and central nervous system. The aim here was to carry out a review of the literature on HHT complications during pregnancy in order to guide management decisions. Main body A literature review was carried out to analyse all publications on complications that occurred during pregnancy in women with HHT. The PubMed/Medline and Scopus databases were searched. The complications observed in HHT women during pregnancy were then described. The authors identified 5 case series and 31 case reports that describe the evolution of 1577 pregnancies in 630 women with HHT. The overall maternal death rate described in the case series was estimated at 1.0% of pregnancies in the case series and 2 maternal deaths occurred in 31 pregnancy case reports. Severe maternal complications occurred in 2.7 to 6.8% of pregnancies in the case series. Severe complications occurred mostly in the second and third trimester in non-diagnosed and non-screened HHT patients. Severe complications were related to visceral involvement. The most frequent complications were related to pulmonary arteriovenous malformations (PAVMs) (haemothorax (n = 10), haemoptysis (n = 4), and severe hypoxaemia (n = 3)). Neurological complications were related to PAVMs in one case (right to left shunt) and to cerebral arteriovenous malformations (CAVM) and intracranial haemorrhage in 2 cases. Complications were related to hepatic arteriovenous malformations (HAVMs) in 8 cases (acutely decompensated heart failure due to hepatic involvement (n = 1), dyspnoea related to heart failure (n = 5), and hepatobiliary necrosis (n = 2)). Conclusion Based on the literature review, most pregnancies in HHT women occur normally. However, these pregnancies should be considered high-risk, given the potential life-threatening events related to AVM rupture. Furthermore, there is currently no international consensus regarding the medical follow-up of pregnancy in women with HHT and the aim here was to carry out a review of the literature in order to guide screening and management decisions for this rare disease.
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Affiliation(s)
- Olivier Dupuis
- Hospices Civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Lyon-Sud, Pierre-Bénite, France.,Université de Lyon, Faculté de médecine, Lyon, France
| | - Laura Delagrange
- Hospices Civils de Lyon, Centre de Référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Bron, France
| | - Sophie Dupuis-Girod
- Hospices Civils de Lyon, Centre de Référence pour la maladie de Rendu-Osler, Hôpital Femme-Mère-Enfants, Bron, France. .,Université Grenoble Alpes, Inserm, CEA, BIG-Biologie du Cancer et de l'Infection, Grenoble, France.
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Borovac-Pinheiro A, Cavichiolli FS, Costa ML, Surita FG. Osler-Weber-Rendu syndrome in pregnancy affecting lungs and brain-a case report. J OBSTET GYNAECOL 2019; 39:709-711. [PMID: 31020882 DOI: 10.1080/01443615.2019.1581739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anderson Borovac-Pinheiro
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas, Campinas , São Paulo , Brazil
| | - Fernanda Schwartz Cavichiolli
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas, Campinas , São Paulo , Brazil
| | - Maria Laura Costa
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas, Campinas , São Paulo , Brazil
| | - Fernanda Garanhani Surita
- a Department of Obstetrics and Gynecology, School of Medical Sciences , University of Campinas, Campinas , São Paulo , Brazil
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Merves M, Parsons K, Alazraki A, Meisel J, Sauer C, Li H. Significant Hematochezia and Intracranial Bleeding in Neonatal Hereditary Hemorrhagic Telangiectasia. AJP Rep 2019; 9:e10-e14. [PMID: 30701124 PMCID: PMC6351274 DOI: 10.1055/s-0039-1677735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/21/2018] [Indexed: 11/02/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an underreported autosomal dominant vascular dysplasia. Neonatal presentations of HHT are rare, as this disorder typically presents in adolescence or beyond with epistaxis. We report a female neonate with hematochezia on the 1st day of life secondary to multiple gastrointestinal arteriovenous malformations (AVMs) along with intracranial hemorrhage. We describe her clinical course and management, as well as her novel family mutation in ENG . This is the first reported HHT case with significant gastrointestinal bleeding in the newborn. We review neonatal HHT and raise the consideration for more directed prenatal imaging and delivery options for fetuses at high risk of HHT.
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Affiliation(s)
- Matthew Merves
- Department of Pediatrics, Division of Neonatology, Emory University, Atlanta, Georgia
| | - Kimberly Parsons
- Department of Pediatrics, Division of Neonatology, Emory University, Atlanta, Georgia
| | - Adina Alazraki
- Department of Radiology, Emory University, Atlanta, Georgia
| | | | - Cary Sauer
- Gastroenterology Section, Emory University, Atlanta, Georgia
| | - Hong Li
- Department of Human Genetics, Emory University, Atlanta, Georgia
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Plowman RS, Javidan-Nejad C, Raptis CA, Katz DS, Mellnick VM, Bhalla S, Cornejo P, Menias CO. Imaging of Pregnancy-related Vascular Complications. Radiographics 2017; 37:1270-1289. [DOI: 10.1148/rg.2017160128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- R. Scooter Plowman
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Cylen Javidan-Nejad
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Constantine A. Raptis
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Douglas S. Katz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Vincent M. Mellnick
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Patricia Cornejo
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
| | - Christine O. Menias
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (R.S.P., C.O.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.J.N., C.A.R., V.M.M., S.B.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); Stony Brook University School of Medicine, Stony Brook, NY (D.S.K.); and Neuroradiology Section, Department of Radiology, Phoenix Children’s Hospital, Phoenix, Ariz (P.C.)
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Robaina Cabrera DM, Verde González MP, Tarazona Chocano B, Amado Fernández C, Zarrabeitia Puente R. Telangiectasia hemorrágica hereditaria: enfermedad de Rendu-Osler-Weber. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.fmc.2016.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Berthelot E, Savale L, Guyot A, Rahmoune FC, Bouchachi A, Assayag P. Acute high output heart failure revealing hereditary hemorrhagic telangiectasia in a pregnant woman. Presse Med 2014; 44:362-5. [PMID: 25534467 DOI: 10.1016/j.lpm.2014.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/22/2014] [Accepted: 08/25/2014] [Indexed: 01/01/2023] Open
Affiliation(s)
- Emmanuelle Berthelot
- University Paris-Sud, 94270 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service de cardiologie, 94270 Le Kremlin-Bicêtre, France.
| | - Laurent Savale
- University Paris-Sud, 94270 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service de pneumologie, DHU Thorax Innovation (DHU TORINO), 94270 Le Kremlin-Bicêtre, France; Inserm UMR_S 999, LabEx LERMIT, hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Anne Guyot
- University Paris-Sud, 94270 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service d'obstétrique, 94270 Le Kremlin-Bicêtre, France
| | - Farid Chakib Rahmoune
- University Paris-Sud, 94270 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service d'anesthésie, 94270 Le Kremlin-Bicêtre, France
| | - Amir Bouchachi
- University Paris-Sud, 94270 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service de cardiologie, 94270 Le Kremlin-Bicêtre, France
| | - Patrick Assayag
- University Paris-Sud, 94270 Le Kremlin-Bicêtre, France; AP-HP, hôpital Bicêtre, service de cardiologie, 94270 Le Kremlin-Bicêtre, France
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Multiple embolizations of pulmonary arteriovenous malformations during pregnancy. CASE REPORTS IN PERINATAL MEDICINE 2014. [DOI: 10.1515/crpm-2014-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Pulmonary arteriovenous malformations in a pregnant patient are rare and can cause deleterious, life-threatening complications. We report a patient with multiple pulmonary arteriovenous malformations, with the subsequent diagnosis of hereditary hemorrhagic telangiectasia, requiring multiple embolizations during pregnancy. Pulmonary arteriovenous malformations can carry a high risk of morbidity in the pregnant woman; however, they can be safely treated in pregnancy.
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Salaria M, Taylor J, Bogwitz M, Winship I. Hereditary haemorrhagic telangiectasia, an Australian cohort: clinical and investigative features. Intern Med J 2014; 44:639-44. [DOI: 10.1111/imj.12457] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/16/2014] [Indexed: 12/13/2022]
Affiliation(s)
- M. Salaria
- Department of Genetics; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - J. Taylor
- Department of Genetics; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - M. Bogwitz
- Department of Genetics; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - I. Winship
- Department of Genetics; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Department of Medicine; MDHS; RMH; University of Melbourne; Melbourne Victoria Australia
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