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Published in: CardioVascular and Interventional Radiology 5/2013

01-10-2013 | Review/State of the Art

Acute Cor Pulmonale and Right Heat Failure Complicating Ethanol Ablative Therapy: Anesthetic and Radiologic Considerations and Management

Authors: Bhiken Naik, Alan H. Matsumoto

Published in: CardioVascular and Interventional Radiology | Issue 5/2013

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Abstract

Ethanol is an effective ablative agent used for the treatment of certain solid organ tumors and vascular malformations (VMs). The egress of ethanol beyond the target tissue can be associated with significant changes to the cardiopulmonary system that can lead to cardiac arrest. This article reviews the contemporary role of ethanol in tumor and VM treatment and discusses the physiological mechanisms of acute pulmonary hypertension and cardiovascular collapse. The importance of periprocedural recognition of the hemodynamic changes that can occur with the use of ethanol and the treatment of this condition are discussed.
Literature
1.
go back to reference Livraghi T, Lazzaroni S, Pellicano S et al (1993) Percutaneous ethanol injection of hepatic tumors: single-session therapy with general anesthesia. AJR Am J Roentgenol 161:1065–1069CrossRefPubMed Livraghi T, Lazzaroni S, Pellicano S et al (1993) Percutaneous ethanol injection of hepatic tumors: single-session therapy with general anesthesia. AJR Am J Roentgenol 161:1065–1069CrossRefPubMed
2.
go back to reference Yakes WF, Rossi P, Odink H (1996) How I do it. Arteriovenous malformation management. Cardiovasc Interv Radiol 19:65–71CrossRef Yakes WF, Rossi P, Odink H (1996) How I do it. Arteriovenous malformation management. Cardiovasc Interv Radiol 19:65–71CrossRef
3.
go back to reference Naik B, Lobato E, Urdaneta F (2004) Acute cardiovascular instability during percutaneous ethanol injection of a hepatocellular carcinoma under general anesthesia. Anesthesiology 100:1307–1308CrossRefPubMed Naik B, Lobato E, Urdaneta F (2004) Acute cardiovascular instability during percutaneous ethanol injection of a hepatocellular carcinoma under general anesthesia. Anesthesiology 100:1307–1308CrossRefPubMed
4.
go back to reference Garel L, Mareschal JL, Gagnadoux MF et al (1986) Fatal outcome after ethanol renal ablation in child with end-stage kidneys. AJR Am J Roentgenol 146:593–594CrossRefPubMed Garel L, Mareschal JL, Gagnadoux MF et al (1986) Fatal outcome after ethanol renal ablation in child with end-stage kidneys. AJR Am J Roentgenol 146:593–594CrossRefPubMed
5.
go back to reference Buchta K, Sands J, Rosenkrantz H et al (1982) Early mechanism of action of arterially infused alcohol USP in renal devitalization. Radiology 145:45–48PubMed Buchta K, Sands J, Rosenkrantz H et al (1982) Early mechanism of action of arterially infused alcohol USP in renal devitalization. Radiology 145:45–48PubMed
6.
go back to reference Ellman BA, Parkhill BJ, Marcus PB et al (1984) Renal ablation with absolute ethanol. Mechanism of action. Investig Radiol 19:416–423CrossRef Ellman BA, Parkhill BJ, Marcus PB et al (1984) Renal ablation with absolute ethanol. Mechanism of action. Investig Radiol 19:416–423CrossRef
7.
go back to reference Alam M, Dokainish H, Lakkis N (2006) Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a systematic review of published studies. J Interv Cardiol 19:319–327CrossRefPubMed Alam M, Dokainish H, Lakkis N (2006) Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a systematic review of published studies. J Interv Cardiol 19:319–327CrossRefPubMed
8.
go back to reference McWilliams JP, Yamamoto S, Raman SS et al (2010) Percutaneous ablation of hepatocellular carcinoma: current status. J Vasc Interv Radiol 21:S204–S213CrossRefPubMed McWilliams JP, Yamamoto S, Raman SS et al (2010) Percutaneous ablation of hepatocellular carcinoma: current status. J Vasc Interv Radiol 21:S204–S213CrossRefPubMed
9.
go back to reference Livraghi T, Benedini V, Lazzaroni S et al (1998) Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma. Cancer 83:48–57CrossRefPubMed Livraghi T, Benedini V, Lazzaroni S et al (1998) Long term results of single session percutaneous ethanol injection in patients with large hepatocellular carcinoma. Cancer 83:48–57CrossRefPubMed
10.
go back to reference Lencioni R, Bartolozzi C, Caramella D et al (1995) Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients. Cancer 76:1737–1746CrossRefPubMed Lencioni R, Bartolozzi C, Caramella D et al (1995) Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients. Cancer 76:1737–1746CrossRefPubMed
11.
go back to reference Shiina S, Tagawa K, Niwa Y et al (1993) Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR Am J Roentgenol 160:1023–1028CrossRefPubMed Shiina S, Tagawa K, Niwa Y et al (1993) Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR Am J Roentgenol 160:1023–1028CrossRefPubMed
12.
go back to reference Livraghi T, Bolondi L, Buscarini L et al (1995) No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. Italian Cooperative HCC Study Group. J Hepatol 22:522–526CrossRefPubMed Livraghi T, Bolondi L, Buscarini L et al (1995) No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. Italian Cooperative HCC Study Group. J Hepatol 22:522–526CrossRefPubMed
13.
go back to reference Behnia R (1995) Systemic effects of absolute alcohol embolization in a patient with a congenital arteriovenous malformation of the lower extremity. Anesth Analg 80:415–417PubMed Behnia R (1995) Systemic effects of absolute alcohol embolization in a patient with a congenital arteriovenous malformation of the lower extremity. Anesth Analg 80:415–417PubMed
14.
go back to reference Do YS, Yakes WF, Shin SW et al (2005) Ethanol embolization of arteriovenous malformations: interim results. Radiology 235:674–682CrossRefPubMed Do YS, Yakes WF, Shin SW et al (2005) Ethanol embolization of arteriovenous malformations: interim results. Radiology 235:674–682CrossRefPubMed
15.
go back to reference Cantasdemir M, Gulsen F, Solak S et al (2012) The use of Onyx for embolization of peripheral vascular malformations in pediatric patients. Pediatr Surg Int 28:477–487CrossRefPubMed Cantasdemir M, Gulsen F, Solak S et al (2012) The use of Onyx for embolization of peripheral vascular malformations in pediatric patients. Pediatr Surg Int 28:477–487CrossRefPubMed
16.
go back to reference Hammer FD, Boon LM, Mathurin P et al (2001) Ethanol sclerotherapy of venous malformations: evaluation of systemic ethanol contamination. J Vasc Interv Radiol 12:595–600CrossRefPubMed Hammer FD, Boon LM, Mathurin P et al (2001) Ethanol sclerotherapy of venous malformations: evaluation of systemic ethanol contamination. J Vasc Interv Radiol 12:595–600CrossRefPubMed
17.
go back to reference Lee JJ, Do YS, Kim JA (2004) Serum ethanol levels after alcohol sclerotherapy of arteriovenous malformations. J Korean Med Sci 19:51–54CrossRefPubMed Lee JJ, Do YS, Kim JA (2004) Serum ethanol levels after alcohol sclerotherapy of arteriovenous malformations. J Korean Med Sci 19:51–54CrossRefPubMed
18.
go back to reference Nimmaanrat S, Prechawai C, Tanomkiat W (2007) Anesthetic techniques and complications in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection. Minerva Anestesiol 73:333–337PubMed Nimmaanrat S, Prechawai C, Tanomkiat W (2007) Anesthetic techniques and complications in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection. Minerva Anestesiol 73:333–337PubMed
19.
go back to reference Chapot R, Laurent A, Enjolras O et al (2002) Fatal cardiovascular collapse during ethanol sclerotherapy of a venous malformation. Interv Neuroradiol 8:321–324PubMed Chapot R, Laurent A, Enjolras O et al (2002) Fatal cardiovascular collapse during ethanol sclerotherapy of a venous malformation. Interv Neuroradiol 8:321–324PubMed
20.
go back to reference Sidi A, Naik B, Muehlschlegel JD et al (2008) Ethanol-induced acute pulmonary hypertension and right ventricular dysfunction in pigs. Br J Anaesth 100:568–569CrossRefPubMed Sidi A, Naik B, Muehlschlegel JD et al (2008) Ethanol-induced acute pulmonary hypertension and right ventricular dysfunction in pigs. Br J Anaesth 100:568–569CrossRefPubMed
21.
go back to reference Shin BS, Do YS, Cho HS et al (2010) Effects of repeat bolus ethanol injections on cardiopulmonary hemodynamic changes during embolotherapy of arteriovenous malformations of the extremities. J Vasc Interv Radiol 21:81–89CrossRefPubMed Shin BS, Do YS, Cho HS et al (2010) Effects of repeat bolus ethanol injections on cardiopulmonary hemodynamic changes during embolotherapy of arteriovenous malformations of the extremities. J Vasc Interv Radiol 21:81–89CrossRefPubMed
22.
go back to reference Shin BS, Do YS, Lee BB et al (2005) Multistage ethanol sclerotherapy of soft-tissue arteriovenous malformations: effect on pulmonary arterial pressure. Radiology 235:1072–1077CrossRefPubMed Shin BS, Do YS, Lee BB et al (2005) Multistage ethanol sclerotherapy of soft-tissue arteriovenous malformations: effect on pulmonary arterial pressure. Radiology 235:1072–1077CrossRefPubMed
23.
go back to reference Rother RP, Bell L, Hillmen P et al (2005) The clinical sequelae of intravascular hemolysis and extracellular plasma hemoglobin: a novel mechanism of human disease. JAMA 293:1653–1662CrossRefPubMed Rother RP, Bell L, Hillmen P et al (2005) The clinical sequelae of intravascular hemolysis and extracellular plasma hemoglobin: a novel mechanism of human disease. JAMA 293:1653–1662CrossRefPubMed
24.
go back to reference Kielstein JT, Hesse G, Bahr MJ et al (2009) Procedure-related pulmonary hypertension in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection—role of ethanol, hemolysis, asymmetric dimethylarginine, and the nitric oxide system. Crit Care Med 37:1483–1485CrossRefPubMed Kielstein JT, Hesse G, Bahr MJ et al (2009) Procedure-related pulmonary hypertension in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection—role of ethanol, hemolysis, asymmetric dimethylarginine, and the nitric oxide system. Crit Care Med 37:1483–1485CrossRefPubMed
25.
go back to reference Mottu F, Stelling MJ, Rufenacht DA et al (2001) Comparative hemolytic activity of undiluted organic water-miscible solvents for intravenous and intra-arterial injection. PDA J Pharm Sci Technol 55:16–23PubMed Mottu F, Stelling MJ, Rufenacht DA et al (2001) Comparative hemolytic activity of undiluted organic water-miscible solvents for intravenous and intra-arterial injection. PDA J Pharm Sci Technol 55:16–23PubMed
26.
go back to reference Schwesinger WH, Kurtin WE (1984) Effects of ethanol infusion on serum hemoglobin and bile pigments. J Surg Res 37:43–47CrossRefPubMed Schwesinger WH, Kurtin WE (1984) Effects of ethanol infusion on serum hemoglobin and bile pigments. J Surg Res 37:43–47CrossRefPubMed
27.
go back to reference Villagra J, Shiva S, Hunter LA et al (2007) Platelet activation in patients with sickle disease, hemolysis-associated pulmonary hypertension, and nitric oxide scavenging by cell-free hemoglobin. Blood 110:2166–2172CrossRefPubMed Villagra J, Shiva S, Hunter LA et al (2007) Platelet activation in patients with sickle disease, hemolysis-associated pulmonary hypertension, and nitric oxide scavenging by cell-free hemoglobin. Blood 110:2166–2172CrossRefPubMed
28.
go back to reference Barnett CF, Hsue PY, Machado RF (2008) Pulmonary hypertension: an increasingly recognized complication of hereditary hemolytic anemias and HIV infection. JAMA 299:324–331CrossRefPubMed Barnett CF, Hsue PY, Machado RF (2008) Pulmonary hypertension: an increasingly recognized complication of hereditary hemolytic anemias and HIV infection. JAMA 299:324–331CrossRefPubMed
29.
go back to reference Kielstein JT, Bode-Boger SM, Hesse G et al (2005) Asymmetrical dimethylarginine in idiopathic pulmonary arterial hypertension. Arterioscler Thromb Vasc Biol 25:1414–1418CrossRefPubMed Kielstein JT, Bode-Boger SM, Hesse G et al (2005) Asymmetrical dimethylarginine in idiopathic pulmonary arterial hypertension. Arterioscler Thromb Vasc Biol 25:1414–1418CrossRefPubMed
30.
go back to reference Kielstein JT, Fliser D, Veldink H (2009) Asymmetric dimethylarginine and symmetric dimethylarginine: axis of evil or useful alliance? Semin Dial 22:346–350CrossRefPubMed Kielstein JT, Fliser D, Veldink H (2009) Asymmetric dimethylarginine and symmetric dimethylarginine: axis of evil or useful alliance? Semin Dial 22:346–350CrossRefPubMed
31.
go back to reference Child JS, Kovick RB, Levisman JA et al (1979) Cardiac effects of acute ethanol ingestion unmasked by autonomic blockade. Circulation 59:120–125CrossRefPubMed Child JS, Kovick RB, Levisman JA et al (1979) Cardiac effects of acute ethanol ingestion unmasked by autonomic blockade. Circulation 59:120–125CrossRefPubMed
32.
go back to reference Kettunen R, Timisjarvi J, Saukko P (1992) The acute dose-related effects of ethanol on right ventricular function in anesthetized dogs. Alcohol 9:149–153CrossRefPubMed Kettunen R, Timisjarvi J, Saukko P (1992) The acute dose-related effects of ethanol on right ventricular function in anesthetized dogs. Alcohol 9:149–153CrossRefPubMed
33.
go back to reference Guarnieri T, Lakatta EG (1990) Mechanism of myocardial contractile depression by clinical concentrations of ethanol. A study in ferret papillary muscles. J Clin Investig 85:1462–1467CrossRefPubMed Guarnieri T, Lakatta EG (1990) Mechanism of myocardial contractile depression by clinical concentrations of ethanol. A study in ferret papillary muscles. J Clin Investig 85:1462–1467CrossRefPubMed
34.
go back to reference Thomas AP, Sass EJ, Tun-Kirchmann TT et al (1989) Ethanol inhibits electrically-induced calcium transients in isolated rat cardiac myocytes. J Mol Cell Cardiol 21:555–565CrossRefPubMed Thomas AP, Sass EJ, Tun-Kirchmann TT et al (1989) Ethanol inhibits electrically-induced calcium transients in isolated rat cardiac myocytes. J Mol Cell Cardiol 21:555–565CrossRefPubMed
35.
go back to reference Ma H, Yu L, Byra EA et al (2010) Aldehyde dehydrogenase 2 knockout accentuates ethanol-induced cardiac depression: role of protein phosphatases. J Mol Cell Cardiol 49:322–329CrossRefPubMed Ma H, Yu L, Byra EA et al (2010) Aldehyde dehydrogenase 2 knockout accentuates ethanol-induced cardiac depression: role of protein phosphatases. J Mol Cell Cardiol 49:322–329CrossRefPubMed
36.
go back to reference Pritts CD, Pearl RG (2010) Anesthesia for patients with pulmonary hypertension. Curr Opin Anaesthesiol 23:411–416CrossRefPubMed Pritts CD, Pearl RG (2010) Anesthesia for patients with pulmonary hypertension. Curr Opin Anaesthesiol 23:411–416CrossRefPubMed
37.
go back to reference Ko JS, Kim CS, Shin BS et al (2011) Changes in pulmonary artery pressures during ethanol sclerotherapy for arteriovenous malformations: identifying the most vulnerable period. Clin Radiol 66:639–644CrossRefPubMed Ko JS, Kim CS, Shin BS et al (2011) Changes in pulmonary artery pressures during ethanol sclerotherapy for arteriovenous malformations: identifying the most vulnerable period. Clin Radiol 66:639–644CrossRefPubMed
38.
go back to reference Prielipp RC, Rosenthal MH, Pearl RG (1988) Vasodilator therapy in vasoconstrictor-induced pulmonary hypertension in sheep. Anesthesiology 68:552–558CrossRefPubMed Prielipp RC, Rosenthal MH, Pearl RG (1988) Vasodilator therapy in vasoconstrictor-induced pulmonary hypertension in sheep. Anesthesiology 68:552–558CrossRefPubMed
39.
go back to reference Sidi A, Naik B, Urdaneta F et al (2008) Treatment of ethanol-induced acute pulmonary hypertension and right ventricular dysfunction in pigs, by sildenafil analogue (UK343–664) or nitroglycerin. Ann Cardiac Anaesth 11:97–104CrossRef Sidi A, Naik B, Urdaneta F et al (2008) Treatment of ethanol-induced acute pulmonary hypertension and right ventricular dysfunction in pigs, by sildenafil analogue (UK343–664) or nitroglycerin. Ann Cardiac Anaesth 11:97–104CrossRef
40.
go back to reference Kim JS, Nam MH, Do YS et al (2010) Efficacy of milrinone versus nitroglycerin in controlling pulmonary arterial hypertension induced by intravenous injections of absolute ethanol in anesthetized dogs. J Vasc Interv Radiol 21:882–887CrossRefPubMed Kim JS, Nam MH, Do YS et al (2010) Efficacy of milrinone versus nitroglycerin in controlling pulmonary arterial hypertension induced by intravenous injections of absolute ethanol in anesthetized dogs. J Vasc Interv Radiol 21:882–887CrossRefPubMed
41.
go back to reference Muehlschlegel JD, Lobato EB, Kirby DS et al (2007) Inhaled amyl nitrite effectively reverses acute catastrophic thromboxane-mediated pulmonary hypertension in pigs. Ann Card Anaesth 10:113–120CrossRefPubMed Muehlschlegel JD, Lobato EB, Kirby DS et al (2007) Inhaled amyl nitrite effectively reverses acute catastrophic thromboxane-mediated pulmonary hypertension in pigs. Ann Card Anaesth 10:113–120CrossRefPubMed
42.
go back to reference Winterhalter M, Antoniou T, Loukanov T (2010) Management of adult patients with perioperative pulmonary hypertension: technical aspects and therapeutic options. Cardiology 116:3–9CrossRefPubMed Winterhalter M, Antoniou T, Loukanov T (2010) Management of adult patients with perioperative pulmonary hypertension: technical aspects and therapeutic options. Cardiology 116:3–9CrossRefPubMed
43.
go back to reference Vlahakes GJ, Turley K, Hoffman JI (1981) The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation 63:87–95CrossRefPubMed Vlahakes GJ, Turley K, Hoffman JI (1981) The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation 63:87–95CrossRefPubMed
44.
go back to reference Rieg AD, Rossaint R, Uhlig S et al (2011) Cardiovascular agents affect the tone of pulmonary arteries and veins in precision-cut lung slices. PLoS ONE 6:e29698CrossRefPubMed Rieg AD, Rossaint R, Uhlig S et al (2011) Cardiovascular agents affect the tone of pulmonary arteries and veins in precision-cut lung slices. PLoS ONE 6:e29698CrossRefPubMed
Metadata
Title
Acute Cor Pulmonale and Right Heat Failure Complicating Ethanol Ablative Therapy: Anesthetic and Radiologic Considerations and Management
Authors
Bhiken Naik
Alan H. Matsumoto
Publication date
01-10-2013
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 5/2013
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-013-0549-7

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