Improvement in exercise performance after pulmonary arteriovenous malformation embolization.

Balloon or coil embolization has become established therapy for multiple PAVMs. We were able to evaluate a 32-year-old woman with multiple PAVMs characterized by significant orthodeoxia, intrapulmonary shunt, dyspnea and limited exercise tolerance before and after balloon and coil embolization. After embolization of three of her largest PAVMs, repeat evaluation revealed improvement in her symptoms, orthodeoxia and intrapulmonary shunt. She was able to exercise two additional work rates with a sustained improvement in oxygenation, a decrease in the P(A-a)O2 difference and higher maximum oxygen consumption. These studies provide objective evidence of persistent improvement in function and endurance at rest and during exercise after embolization.