Journal Article

P287 Intrapulmonary shunt detection in HHT: standardized technique for agitated saline (bubble echo) studies

Hill, M, Choy, J, Jeerakathil, T, Vethanayagam, D, Selvakumar, L, Rashkovetsky, R

2025

Overview

Introduction and ObjectivesIntrapulmonary right-to-left shunts (RLS) are an important clinical concern in individuals with Hereditary Hemorrhagic Telangiectasia (HHT). Along with respiratory symptoms like dyspnea, serious neurological complications can arise including ischemic strokes and brain abscess. HHT is an autosomal dominant genetic disorder characterized by arteriovenous malformations (AVMs), with pulmonary AVMs (PAVMs) being a common manifestation that contributes to intrapulmonary shunting. Screening for PAVMs is important in HHT to prevent risks of paradoxical embolization, appropriate management and rarely death from pulmonary hemorrhage. Agitated saline contrast echocardiography (‘bubble echo studies’) are done through HHT Centers to identify RLS and grading the same when present, and are recommended through the International HHT Guidelines. Western Canada has a large rural/remote population, and therefore satellite HHT clinics by health jurisdiction and associated echo labs performing these studies have been recommended to improve access to care and hopefully maintain quality of RLS assessments. This policy study aimed to assess the written policies governing bubble echo techniques and protocols in use within accredited echo labs across the province of Alberta, Canada.MethodsWe conducted an observational cross-sectional study at a single time point (as of July 15, 2024) to evaluate the practices and protocols used in echocardiographic assessments for RLS to screen individuals with HHT - working with the provincial accreditation body, the College of Physicians and Surgeons of Alberta (CPSA). All CPSA-accredited adult echo lab facilities were contacted (telephone/email/in-person). Policy data was collected on the proportion of CPSA-accredited labs specifically performing shunt assessments, including review of available written policies for the shunt assessment protocols.ResultsA total of 62 CPSA-accredited adult echocardiography facilities were reviewed, of which only 12 reported performing bubble echo studies for RLS assessment. The policy review of the participating echo labs revealed notable variations in the saline injection techniques and the grading scales/criteria used for shunt evaluation in bubble echo studies.Abstract P287 Table 1Comparison of shunt assessment protocols across accredited echo labsConclusionCurrent accreditation criteria in Alberta and other health jurisdictions do not mandate a standardized protocol for bubble echo shunt assessments. Considering a standardized protocol could reduce variability between labs and allow for more reliable comparisons over time.

• Publisher: BMJ Publishing Group LTD
• Subject: Accreditation