#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) Part I. Pathophysiology, clinical symptoms and recommend screening for vascular malformations


Authors: Zdeněk Adam 1;  Dagmar Brančiková 1;  Gabriela Romanová 2;  Luděk Pour 1;  Marta Krejčí 1;  Jiří König 3;  Tomáš Nebeský 4;  Zuzana Adamová 5;  Martin Štork 1;  Martin Krejčí 1;  Sabina Ševčíková 4;  Michal Eid 1;  Zdeněk Král 1
Authors‘ workplace: Interní hematologická a onkologická klinika LF MU a FN Brno 1;  Oddělení klinické hematologie FN Brno 2;  Oddělní krční, nosní ušní FN Brno 3;  Ústav patologické fyziologie LF MU a FN Brno 4;  Chirurgické oddělení nemocnice Vsetín 5
Published in: Vnitř Lék 2021; 67(6): 339-344
Category: Review Articles

Overview

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, is an autosomal dominant disorder that causes abnormal blood vessel formation. Patients with HHT may have telangiectasias and later may develop arteriovenous malformations in various organs. Pacients suffer from many complications caused by the malformations and therefore by patients with HHT must by performed screening of this arteriovenous malformations. Optimal treatment of this malformations is best delivered throught a multidisciplinary approach. Farmacological treatment is described in next paper.

Keywords:

hereditary hemorrhagic teleangiectasia – arteriovenous malformations


Sources

1. Faughnan ME, Mager JJ, Hetts SW et al.Second International Guidelines for the Diagnosis and Management of Hereditary Hemorrhagic Telangiectasia. Ann Intern Med. 2020; 173(12): 989–1001. doi: 10.7326/M20–1443.

2. Al-Samkari H. Hereditary hemorrhagic telangiectasia: systemic therapies, guidelines, and an evolving standard of care. Blood. 2021;137(7):888–895. doi: 10.1182/blood. 2020008739.

3. Ferry AM, Wright AE, Baillargeon G et al. Epidemiology and Trends of Hereditary Hemorrhagic Telangiectasia in the United States. Am J Rhinol Allergy. 2020; 34(2): 230–237. doi: 10.1177/1945892419886756.

4. de Gussem EM, Edwards CP, Hosman AE et al. Life expectancy of parents with Hereditary Haemorrhagic Telangiectasia. Orphanet J. Rare Dis. 2016; 11: 46. doi: 10.1186/s13023– 016–0427-x.

5. Thompson KP, Nelson J, Kim H et al. Brain Vascular Malformation Consortium HHT Investigator Group. Predictors of mortality in patients with hereditary hemorrhagic telangiectasia. Orphanet J Rare Dis. 2021; 16(1): 12. doi: 10.1186/s13023–020–01579–2.

6. de Gussem EM, Kroon S, Hosman AE et al. Hereditary Hemorrhagic Telangiectasia (HHT) and Survival: The Importance of Systematic Screening and Treatment in HHT Centers of Excellence. J Clin Med. 2020; 9(11): 3581. doi: 10.3390/jcm9113581.

7. Kritharis A, Al-Samkari H, Kuter DJ. Hereditary hemorrhagic telangiectasia: diagnosis and management from the hematologist's perspective. Haematologica. 2018; 103(9): 1433–1443.

8. Shovlin CL, Guttmacher AE, Buscarini E et al. Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome) Am J Med Genet. 2000; 91: 66–67.

9. Snellings DA, Gallione CJ, Clark DS et al. Somatic Mutations in Vascular Malformations of Hereditary Hemorrhagic Telangiectasia Result in Bi-allelic Loss of ENG or ACVRL1. Am J Hum Genet. 2019; 105(5): 894–906.

10. Shovlin CL, Simeoni I, Downes K et al. Mutational and phenotypic characterization of hereditary hemorrhagic telangiectasia. Blood. 2020; 136(17): 1907–1918. doi: 10.1182/ blood.2019004560.

11. McDonald J, Wooderchak-Donahue W et al. Hereditary hemorrhagic telangiectasia: genetics and molecular diagnostics in a new era. Front Genet. 2015; 6: 1. doi: 10.3389/ fgene.2015.00001.

12. Garg N, Khunger M, Gupta A, Kumar N. Optimal management of hereditary hemorrhagic telangiectasia. J Blood Med. 2014; 5: 191–206. doi: 10.2147/JBM.S45295.

13. Nevoralová Z. Teleangiectasia hereditaria haemorrhagica. Dermatologie pro praxi. 2007; 1(3): 130–131.

14. Brinjikji W, Iyer VN, Yamaki V et al. Neurovascular Manifestations of Hereditary Hemorrhagic Telangiectasia: A Consecutive Series of 376 Patients during 15 Years. AJNR Am J Neuroradiol 2016; 37(8): 1479–1486.

15. Chowdhury FN, Chandrarathne GS, Masilamani KD et al. Between Strokes and Hereditary Hemorrhagic Telangiectasia: A Population-Based Study. Can J Neurol Sci. 2019; 46( 1): 44–50.

16. Hanoun G, Vybíhal V, Sova M et al. Absces mozku jako první klinická manifestace hereditární hemoragické teleangiektázie – tři kazuistiky. Česká a slovenská neurologie a neurochirurgie. 2015; 78(3): 348–353.

17. Polák P, Snopková S, Husa P. Polymikrobieller Hirnabszess bei hereditärer hämorrhagischer Teleangiektasie (Morbus Osler). Deutsche Medizinische Wochenschrift. 2012; 137(33): 1635–1638.

18. Tellapuri S, Park HS, Kalva SP. Pulmonary arteriovenous malformations. Int J Cardiovasc Imaging. 2019; 35(8): 1421–1428.

19. Dupuis-Girod S, Cottin V, Shovlin CL. The Lung in Hereditary HemorrhagicTelangiectasia. Respiration. 2017; 94(4): 315–330.

20. Yokokawa T, Sugimoto K, Kimishima Y e al. Pulmonary Hypertension and Hereditary Hemorrhagic Telangiectasia Related to an ACVRL1 Mutation. Intern Med. 2020; 59(2): 221–227.

21. Harder EM, Fares WH. Hospitalizations with hereditary hemorrhagic telangiectasia and pulmonary hypertension in the United States from 2000 to 2014. Respir Med. 2019; 147: 26–30.

22. Lischke R, Pafko P, Šimonek J et al. Bilateral pulmonary arteriovenous malformations in patient with Rendu-Osler-Weber disease European journal of cardio-thoracic surgery. 2004; 25(3): 461–463.

23. Takáč M, Koval Š, Klimčík J. Hereditárne hemoragické teleangiektázie s narastaním arteriovenóznych fistúl po 24 rokoch. Vnitřní lékařství. 1997; 43(9): 599–601.

24. Žurková M, Köcher M, Kolek V. Problematika plicních arteriovenózních zkratů. Studia pneumologica et phtiseologica. 2002; 62(1): 33–35.

25. Olsen LB, Kjeldsen AD, Poulsen MK et al. High output cardiac failure in 3 patients with hereditary hemorrhagic telangiectasia and hepatic vascular malformations, evaluation of treatment. Orphanet J Rare Dis. 2020; 15(1): 334. doi: 10.1186/s13023–020–01583–6.

26. Wu PR, Horwith A, Mai S et al. High-Output Cardiac Failure Due to Hereditary Hemorrhagic Telangiectasia: A Case of an Extra-Cardiac Left to Right Shunt. Int J Angiol. 2017; 26(2): 125–129.

27. Doležal J. Kvantifikace pravo-levého zkratu u pacientky s mnohočetnými plicními arteriovenózními malformacemi v rámci hemoragické hereditární teleangiektázie pomocí celotělové scintigrafies 99mTc-makroagregátem. Vnitřní lékařství. 2008; 54(2): 206–209.

28. Singh K, Zubair A, Prindle A et al. Diagnostic yield of capsule endoscopy for small bowel arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia: a systematic review and meta-analysis. Endosc Int Open 2019; 7(2): E282-E289. doi: 10.1055/a-0799–9820.

29. Doležal J, Vižďa J, Kopáčová M et al. Lokalizace zdroje recidivujícího krvácení v tenkém střevě u hemoragické hereditární teleangiektazie pomocí scintigrafie s in vivo označenými erytrocyty pomocí 99mTc-pertechnetátu. Vnitřní lékařství. 2005; 51(5): 583–587.

30. Doležal J, Vižďa J, Bureš J. Přínos scintigrafie s autologními označeními erytrocyty k určení místa krvácení v tenkém střevě. Folia gastroentrerologica et hepatologica. 2004; 2(1): 13–20.

31. Doležal J, Vižďa J, Kopáčová J et al. Lokalizace zdroje recidivujícího krvácení v tenkém střevě u hemoragické hereditární teleangiektazie pomocí scintigrafie s in vivo označenými erytrocyty pomocí 99mTc-pertechnetátu Vnitřní lékařství. 2005; 51(5): 583–587.

32. Cihlář F, Laštůvka J, Krajina A et al. Multidetektorové CT v diagnostice zdroje recidivujícího gastrointestinálního krvácení. Česká radiologie. 2009; 63(2): 159–162.

33. Tortora A, Riccioni ME, Gaetani E et al.. Rendu – Osler-Weber disease: a gastroenterologist's perspective. Orphanet J Rare Dis. 2019; 14(1): 130. doi: 10.1186/s1301

34. Welle CL, Welch BT, Brinjikji W et al. Abdominal manifestations of hereditary hemorrhagic telangiectasia: a series of 333 patients over 15 years. Abdom Radiol (NY). 2019; 44(7): 2384–2391.

35. Jackson SB, Villano NP, Benhammou JN et al. Gastrointestinal Manifestations of Hereditary Hemorrhagic Telangiectasia (HHT): A Systematic Review of the Literature. Dig Dis Sci. 2017; 62(10): 2623–2630.

36. Harwin J, Sugi MD, Hetts SW et al. The Role of Liver Imaging in Hereditary Hemorrhagic Telangiectasia. J Clin Med. 2020; 9(11): 3750. doi: 10.3390/jcm9113750.

37. Černý E, Hušek K, Studeník P et al. Uncommon vascular transformation in explanted liver. Scripta medica Facultatis medicae Universitatis Brunensis Masarykianae. 1999; 72(2/3): 97–102.

38. CURA MA, Postoak D, Speeg VK et al. Transjugular Intrahepatic Portosystemic Shunt for Variceal Hemorrhage due to Recurrent of Hereditary Hemorrhagic Telangiectasia in a Liver Transplant. 2010; 21(1): 135–139.

39. Gran´Maison A. Hereditary hemorrhagic telangiectasia. Canadian Medical Assotiation Journal Praktice 2009; 180(8): 833–835.

40. Soysal N, Eyries M, Verlhac S et al. Non-invasive CT screening for pulmonary arteriovenous malformations in children with confirmed hereditary hemorrhagic telangiectasia: Results from two pediatric centers. Pediatr Pulmonol. 2017; 52(5) :642–649. doi: 10.1002/ppul.23649.

41. Kilian A, Clancy MS, Olitsky S et al. Screening for pulmonary and brain vascular malformations is the North American standard of care for patients with hereditary hemorrhagic telangiectasia (HHT): A survey of HHT Centers of Excellence. Vasc Med. 2021; 26(1): 53–55. doi: 10.1177/1358863X20974452.

42. Ribeiro E, Cogez J, Babin E et al. Stroke in hereditary hemorrhagic telangiectasia patients. New evidence for repeated screening and early treatment of pulmonary vascular malformations: two case reports. BMC Neurol. 2011; 11: 84. doi: 10.1186/1471–2377–11–84.

43. Buscarini E, Danesino C, Olivieri C et al. Doppler ultrasonographic grading of hepatic vascular malformations in hereditary hemorrhagic telangiectasia – results of extensive screening. Ultraschall Med. 2004; 25(5): 348–55. doi: 10.1055/s-2004–813549.

44. Buscarini E, Buscarini L, Danesino C et al. Hepatic vascular malformations in hereditary hemorrhagic telangiectasia: Doppler sonographic screening in a large family. J Hepatol. 1997; 26(1): 111–118. doi: 10.1016/s0168–8278(97)80017–7.

45. Kjeldsen AD, Oxhøj H, Andersen P et al. Pulmonary arteriovenous malformations: screening procedures and pulmonary angiography in patients with hereditary hemorrhagic telangiectasia. Chest. 1999; 116(2): 432–4399. doi: 10.1378/chest.116.2.432.

46. Folz BJ, Wollstein AC, Alfke H et al. The value of screening for multiple arterio-venous malformations in hereditary hemorrhagic telangiectasia: a diagnostic study. Eur Arch Otorhinolaryngol. 2004; 261(9): 509–516. doi: 10.1007/s00405–003–0719–3.

47. Parra JA, Cuesta JM, Zarrabeitia R et al. Screening pulmonary arteriovenous malformations in a large cohort of Spanish patients with hemorrhagic hereditary telangiectasia. Int J Cardiol. 2016; 218: 240–245. doi: 10.1016/j.ijcard.2016.05.065.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 6

2021 Issue 6

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#