LAUSR

BACKGROUND High-resolution chest CT (HRCT) is recommended after PAVM embolotherapy to assess for PAVM persistence and untreated PAVM growth. Graded transthoracic contrast echocardiography (TTCE) predicts need for embolotherapy in PAVM screening. This study sought to determine whether post-embolotherapy graded TTCE can similarly predict need for repeat embolotherapy. METHODS Thirty-two patients (8M:24F, mean age 51.1 ± 12.6 years) with prior PAVM embolotherapy and follow-up HRCT were prospectively enrolled. Patients underwent graded TTCE using a validated 3-point quantitative grading scale. TTCE grade and HRCT findings were compared. RESULTS Median time between most recent HRCT and TTCE was 7 days (interquartile range 0-272 days). Thirty patients (94%) had no PAVMs requiring repeat embolotherapy on HRCT. Two patients (6%) had PAVMs requiring repeat embolotherapy (FA ≥ 3 mm), 1 with untreated PAVM growth and 1 with treated PAVM persistence. TTCE was positive in 88% (n=28) of patients. All patients (n=4, 12%) with negative TTCE had no visible PAVMs on HRCT. Nine patients (32%) had grade 1 shunt, ten (35%) had grade 2 shunt, and nine (32%) had grade 3 shunt. No patients with grade 1 shunt had PAVMs amenable to repeat embolotherapy on HRCT. All patients (n=2) with PAVMs requiring repeat embolotherapy (FA ≥ 3 mm) had grade 3 shunt. TTCE grade was significantly associated PAVM feeding artery diameter (P < 0.001). CONCLUSIONS Post-embolotherapy graded TTCE can predict need for repeat embolotherapy on HRCT. Patients with negative TTCE and grade 1 shunt may not require HRCT follow-up and can potentially be followed with serial graded TTCE.