Rapid onset of intrapulmonary arteriovenous shunting after surgical repair of tetralogy of Fallot with pulmonary atresia

Ofoe, Victor; Pratap, Usha; Slavík, Zdeněk

doi:10.1017/s1047951101000191

Cited by 5 publications

(1 citation statement)

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“…86 Very rarely, intrapulmonary arteriovenous shunting can be seen rapidly after biventricular surgical repair of pulmonary atresia and ventricular septal defect, again likely reflecting recruitment and dilation of pre-existing vascular channels rather than from angiogenesis. 87 Kawashima et al speculate that pulmonary arteriovenous malformations occur only in a minority of patients following a total cavopulmonary shunt operation, presumably with hepatic venous exclusion, and seldom occur in older patients. 71 Kawashima et al also suggest that older patients develop a collateral circulation that delivers this putative hepatic factor to the lungs, thus preventing disadvantageous lung vascular remodelling.…”

Section: Intersection With the Hepatopulmonary Syndromementioning

confidence: 99%

The biological “scrabble” of pulmonary arteriovenous malformations: considerations in the setting of cavopulmonary surgery

2004

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Pulmonary arteriovenous fistulas are vascular malformations, which, by virtue of producing abnormal vascular connections proximal to the units of gas exchange, result in intrapulmonary right-to-left shunting. These malformations or fistulas reflect at least in part disordered angiogenesis, and less commonly recruitment and dilation of pre-existing vascular channels. Pulmonary arteriovenous fistulas occur in a number of diverse clinical settings. Such fistulas are a well-established feature of the Weber-Osler-Rendu complex, or hereditary haemorrhagic telangiectasia, an autosomal dominant vascular dysplasia characterized by mucocutaneous telangiectasis, epistaxis, gastrointestinal haemorrhage, and arteriovenous malformations in the lung, brain, liver and elsewhere. They are also seen in the patient with acute or chronic liver disease, disease that is usually but not invariably severe, or those with non-cirrhotic portal hypertension. They may occur as congenital malformations, single or diffuse, large or small in isolation, and when large or extensive enough may result in hypoxaemia, clinical cyanosis, and heart failure. Cerebral vascular accidents are also a well-known complication of this disorder. An extensive literature has accumulated with regard to the pulmonary arteriovenous fistulas seen in the setting of the Weber-Osler-Rendu complex, and there is considerable information on the genetics, basic biology, clinical findings, complications and therapeutic interventions of these malformations in the setting of this syndrome. These issues, however, are not the primary considerations of this review, although some aspects of this fascinating disorder will be discussed later. Rather the focus will be on pulmonary arteriovenous malformations that develop in the setting of cavopulmonary surgery, and their relationship to the pulmonary arteriovenous fistulas occurring in the hepatopulmonary syndrome. The complex tapestry of these overlapping and intersecting clinical observations will be unfolded in the light of their chronology.

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Section: Intersection With the Hepatopulmonary Syndromementioning

confidence: 99%