Pulmonary AV Malformations After Superior Cavopulmonary Connection: Resolution After Inclusion of Hepatic Veins in the Pulmonary Circulation

Shah, Maully J.; Rychik, Jack; Fogel, Mark A.; Murphy, John D.; Jacobs, Marshall L.

doi:10.1016/s0003-4975(96)00961-7

Cited by 175 publications

(117 citation statements)

References 10 publications

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“…This is not the forum to explore all these issues, but a few words about pulmonary arteriovenous malformations are germane. [131][132][133][134][135][136][137][138][139][140][141][142] The etiology for the development of pulmonary arteriovenous malformations after the Fontan operation remains uncertain. Clinical practice currently suggests that exclusion of the hepatic veins and hepatic venous effluent from the pulmonary circuit may be causal to the development of pulmonary arteriovenous malformations and that inclusion of the hepatic venous blood into the pulmonary circuit may reverse their formation.…”

Section: Right Heart Bypass and The Fontan Experiencementioning

confidence: 99%

Pediatric Cardiology and Cardiovascular Surgery: 1950-2000

Freedom

Lock²,

Bricker³

2000

Circulation

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Section: Right Heart Bypass and The Fontan Experiencementioning

confidence: 99%

Pediatric Cardiology and Cardiovascular Surgery: 1950-2000

Freedom

Lock²,

Bricker³

2000

Circulation

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“…, and Shah et al 35 confirm the hypothesis of the role played by the hepatic factor in the formation of the pulmonary arteriovenous fistulae by showing the appearance of fistulae after the Kawashima operation 32 , and their partial 34 or complete 35 disappearance after the incorporation of the supra-hepatic veins into the pulmonary circulation. In our study, of the 8 patients with pulmonary arteriovenous fistulae undergoing total cavopulmonary operation, complete regression occurred in 3 and partial in 2, the latter with bilateral fistulae.…”

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confidence: 80%

Contribuição para o diagnóstico e o tratamento das fístulas arteriovenosas pulmonares após a operação de Glenn bidirecional

Santana¹,

Paulista²,

Pontes³

et al. 2004

Arq. Bras. Cardiol.

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ObjectiveTo determine the incidence of pulmonary arteriovenous fistulae (PAVFs) after the bidirectional Glenn operation and the possible independent variables that could influence their appearance; to confirm the use of microbubble contrast echocardiography for the detection of PAVFs; and to test the sensitivity and specificity of pulmonary angiography. MethodsFrom March 1990 to December 1995 patients were operated upon. Their ages ranged from 2 to 132 months (mean, 32.7± 33.6 Conclusion The incidence of PAVFs after the bidirectional Glenn operation was high (37%). The time interval elapsed after the bidirectional Keywords pulmonary arteriovenous fistulae, bidirectional Glenn operation, microbubble contrast echocardiographyCyanogen congenital heart diseases, which behave functionally as univentricular heart, are usually characterized by a poor prognosis, unsatisfactory quality of life, and impossibility of surgical correction that reestablishes the normal cardiac anatomy.In the past 4 decades, several proposals for palliative operations have been tested, initially in experimental animals, and then, if successful, in children with such defects. One of them, the Glenn operation, was based on the principle that systemic venous blood might reach the pulmonary circulation without the participation of the right cardiac cavities. This operation was experimentally proposed by Carlon et al 1 in 1951, successfully performed for the first time by Meshalkin 2 and Bakulev 3 in 1956, and diffused by Glenn 4 in 1958. The classical Glenn operation, as this procedure has been known, remained unaltered for many years. Haller et al 5 experimentally introduced the concept of bilateral partial cavopulmonary anastomosis, in which the continuity between the pulmonary arteries was preserved by a terminolateral anastomosis between the superior vena cava and the right pulmonary artery.Azzolina et al 6 performed that operation for the first time, which became known as the bidirectional Glenn operation. The major advantage of this technique was that the right pulmonary artery, not separated from the confluence, allowed the division of the blood volume of the superior vena cava between both lungs.Mathur and Glenn 7 reported the late evolution of 56 patients out of 63 who underwent the classical Glenn operation and described for the first time the development of pulmonary arteriovenous fistulae in that type of operation. From this publication onwards, other studies reported such complications 8,9 , decreasing the enthusiasm in regard to the classical Glenn operation, which was then abandoned in favor of the bidirectional Glenn operation 6,10 . MethodsFrom March 1990 to December 1995, 59 patients with complex cyanogen congenital heart diseases underwent the bidirectional Glenn operation at our service. Five patients died, 4 immediately after the procedure and one during hospitalization. The 54 survivors comprised the case series of this study. Age, on the occasion of the operation, varied from 2 to 132 (mean, 31.4±33.56; median, 18.5) mont...

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“…O desenvolvimento das FAVP foi inicialmente atribuído a característica do fluxo na circulação pulmonar após a operação de Glenn, que foi transformado de pulsátil em contínuo, porém a etiologia ainda é desconhecida (17) .…”

Section: Fístula Arteriovenosa Pulmonarunclassified

“…Atualmente, considera-se que as FAVP estejam relacionadas com o desvio do fluxo sangüíneo hepático da circulação pulmonar, como constatado em pacientes submetidos a DCPB. Considera-se que substâncias sintetizadas no fígado, desviadas da circulação pulmonar, propiciariam a formação da FAVP (16,17) .…”

Section: Introductionunclassified

Estudo angiográfico comparativo da artéria pulmonar no pré e pós-operatório de pacientes submetidos a operação de derivação cavopulmonar bidirecional

Westphal¹,

Maluf²,

Silva³

et al. 2001

Rev Bras Cir Cardiovasc

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Estudo angiográfico comparativo da artéria pulmonar no pré e pós-operatório de pacientes submetidos a operação de derivação cavopulmonar bidirecional. Casuística e Métodos: Foram incluídos 18 pacientes submetidos a DCPB, no período de março de 1990 a janeiro de 1997, que possuíam exames cineangiográficos disponíveis no período pré e pós-operatório. As medidas da AP direita e esquerda foram realizadas em três locais: na origem, imediatamente antes da bifurcação e no início da artéria do lobo inferior. Em seguida, os diâmetros de cada local foram indexados à superfície corpórea ou ao diâmetro da aorta, medido na altura do diafragma. Os dados angiográficos e oximétricos foram submetidos a análise estatística.Resultados: Quando analisados os diâmetros absolutos observou-se que a maioria sofreu aumento não-significante, no período pós-operatório, ao passo que o diâmetro II da AP esquerda apresentou diminuição. Os índices totais I e III apresentaram diminuição significante, no período pós-operatório, e no índice total II a redução não foi significante. A análise da variável seguimento pós-operatório demonstrou redução significativa dos índices totais nos pacientes com seguimento pós-operatório inferior a 23,6 meses. A presença de fluxo sangüíneo adicional determinou o aumento dos índices AP direita II e III, e pequena redução nos outros índices. As medidas da AP indexadas pelo diâmetro da aorta revelaram comportamento semelhante à indexação pela superfície corpórea. Na ausência de circulação venosa colateral (CVC) observou-se aumento significante da saturação de O 2, por outro lado, a sua presença determinou um aumento não-significante, durante o período de observação.

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Pulmonary AV Malformations After Superior Cavopulmonary Connection: Resolution After Inclusion of Hepatic Veins in the Pulmonary Circulation

Cited by 175 publications

References 10 publications

Pediatric Cardiology and Cardiovascular Surgery: 1950-2000

Pediatric Cardiology and Cardiovascular Surgery: 1950-2000

Contribuição para o diagnóstico e o tratamento das fístulas arteriovenosas pulmonares após a operação de Glenn bidirecional

Estudo angiográfico comparativo da artéria pulmonar no pré e pós-operatório de pacientes submetidos a operação de derivação cavopulmonar bidirecional

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