Systemic-to-Pulmonary Shunt Embolization Improves Right Heart Hemodynamics in Bronchiectasis

In 20 bronchiectasis patients, embolization of systemic-to-pulmonary arterial shunts raised stroke volume (64.8→76.8 ml, p=0.048) and right ventricular ejection fraction (43.0→48.8%, p=0.034) within 48 h. Small, uncontrolled study; larger trials needed.

• Before-after cohort study, n=20 (mean age 56 y, 30% male); right heart catheterization and cardiac MRI performed pre- and within 24–48 h post-embolization.
• Shunt volume between ventricles fell from 20.67±9.52 ml to 9.50±6.47 ml (p=0.017); pulmonary artery wedge pressure and shunt oxygen saturation also decreased significantly (p=0.004 and p=0.009); cardiac output and index trended upward but did not reach significance.
• Critical limitation: no control arm, very small sample (n=20), and hemodynamic assessment only at 24–48 h — durability of benefit is unknown.

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