| Pulmonary arteriovenous malformations after a Fontan operation in the left isomerism and absent inferior vena cava. | |
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MedLine Citation:
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PMID: 19369088 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the occurrence of pulmonary arteriovenous malformations after a Fontan operation in the left isomerism and absent inferior vena cava. METHODS: We retrospectively reviewed 19 patients with the left isomerism and absent inferior vena cava who underwent Fontan operations at our institution. We divided the patients into two groups: bilateral superior vena cava (group A, n=9), and single superior vena cava (group B, n=10). Median age at Fontan operation was 6.2 years (1.0-24.1). Diagnosis of pulmonary arteriovenous malformations was made by pulmonary angiography and bubble contrast echocardiography. RESULTS: Median follow-up was 5.3 years (0.2-17.3) with one hospital death. Seven patients suffered from pulmonary arteriovenous malformations. In six out of the seven patients, the occurrence of pulmonary arteriovenous malformations was related to biased pulmonary perfusion of the hepatic venous flow. In group A, the distance between the dominant superior vena cava (which the venous flow from the lower half of the body drains into) and the hepatic venous channel over the distance between the smaller superior vena cava and the hepatic venous channel was larger in patients with pulmonary arteriovenous malformations than in patients without pulmonary arteriovenous malformations (3.83+/-1.28 vs 1.53+/-1.45, p=0.071). In group B, pulmonary arteriovenous malformations developed in two patients whose venous channels did not overlap. Pulmonary arteriovenous malformations developed in only one patient after we changed the hepatic venous channel design to approximate the hepatic venous channel to the dominant superior vena cava as closely as possible. CONCLUSIONS: We might prevent pulmonary arteriovenous malformations in patients with the left isomerism and absent inferior vena cava by designing the venous channels to achieve better mixing of the superior vena cava and the hepatic venous flow. |
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Authors:
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Yuki Nakamura; Toshikatsu Yagihara; Koji Kagisaki; Ikuo Hagino; Junjiro Kobayashi |
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Publication Detail:
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Type: Journal Article Date: 2009-04-14 |
Journal Detail:
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Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 36 ISSN: 1873-734X ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 2009 Jul |
Date Detail:
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Created Date: 2009-06-22 Completed Date: 2009-10-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: Germany |
Other Details:
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Languages: eng Pagination: 69-76; discussion 76 Citation Subset: IM |
Affiliation:
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Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Arteriovenous Fistula / diagnosis, etiology* Child Child, Preschool Epidemiologic Methods Female Fontan Procedure / adverse effects* Heart Catheterization Hemodynamics Hepatic Veins / physiopathology Humans Infant Male Pulmonary Artery / abnormalities* Pulmonary Circulation Pulmonary Veins / abnormalities* Vena Cava, Inferior / abnormalities* Vena Cava, Superior / abnormalities Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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