Patients with a confirmed diagnosis of arteriovenous malformation (AVM) with hemodynamically relevant shunt volume should undergo cardiologic evaluation before planned treatment. Contrast echocardiography plays an important role in this process. The cardiac output at rest should be determined sonographically (before and after surgery), an ECG with rhythm analysis should be performed (tachyarrhythmias?) and NT-proBNP should be measured in the laboratory (signs of heart failure?).
If a relevant right-to-left shunt with the risk of paradoxical embolism is present, e.g., in the context of Osler’s disease, antibiotic prophylaxis should also be considered whenever there is even a minor intervention (such as professional dental care) in view of the risk of brain abscess and myocarditis. In addition, anticoagulation also plays an important role.
Multiple prophylactic embolizations in staged steps of a large arteriovenous malformation of the liver in patients with Osler’s disease is necessary, especially when the first signs of right heart failure or pulmonary arterial hypertension appear.