Am J Cardiol：肺动静脉畸形患者可因反常栓子引发心肌缺血

　　美国一项研究表明，在未治疗的肺动静脉畸形（PAVM）患者中，心脏缺血可由反常栓子通过PAVM进入冠状动脉而引发。论文于5月23日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　此项研究共纳入98例PAVM患者，其中84例接受PAVM栓塞治疗，其余14例患者因PAVM太小而无法实施栓塞。就心肺症状和心脏诊断病史通过电话对患者进行调查。

　　结果显示，6例患者报告在PAVM栓塞治疗前出现过典型心绞痛样胸痛或心肌梗死。在33例症状性PAVM患者中上述患者占18%，在整体98例患者占6%。5例患者接受了心导管检查，其中4例冠脉正常，1例伴有单支冠脉闭塞。

Angina Pectoris or Myocardial Infarctions, Pulmonary Arteriovenous Malformations, Hereditary Hemorrhagic Telangiectasia, and Paradoxical Emboli
Abstract
Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder characterized by vascular malformations, and many clinical complications are related to pulmonary arteriovenous malformations (PAVMs) because they provide direct right-to-left shunts. Paradoxical emboli through these shunts are a well-recognized cause of transient ischemic attack, stroke, and cerebral abscess. The aim of this study was to determine whether paradoxical emboli through PAVMs could manifest as cardiac ischemic events. The study included a single-center population of 98 patients with PAVMs. Eighty-four had undergone PAVM embolotherapy, and the remaining 14 patients had PAVMs too small to require embolization. Patients were interviewed by telephone and surveyed regarding their cardiopulmonary symptoms and histories of cardiac diagnoses. We found that 6 patients (which is 18% of patients with symptomatic PAVMs, n = 33, and 6% of the total cohort, n = 98) reported that they had experienced typical angina pectoris-like chest pain or had a myocardial infarction before PAVM embolotherapy. Five patients had had a cardiac catheterization, 4 had normal coronary arteries, and 1 had a single artery occlusion. In conclusion, we suggest that in patients with untreated PAVMs, cardiac ischemia can occur because of a paradoxical embolus through PAVMs to a coronary artery.