title: A detailed histologic analysis of pulmonary arteriovenous malformations in children with cyanotic congenital heart disease.
abstract: BACKGROUND
  Pulmonary arteriovenous malformations are a common cause of progressive cyanosis in children after cavopulmonary anastomoses. We analyzed the pulmonary histologic characteristics from children in whom pulmonary arteriovenous malformations developed after procedures that resulted in pulmonary arterial blood flow devoid of hepatic venous effluent.
  
  
  METHODS
  We performed routine histologic studies, immunohistochemical staining, and electron microscopic analysis of peripheral lung biopsy specimens from 2 children with angiographically proven pulmonary arteriovenous malformations. Microvessel density was determined with a computer-assisted, morphometric analysis system.
  
  
  RESULTS
  Histologic examination demonstrated large, dilated blood vessels ("lakes") and clustered, smaller vessels ("chains") in the pulmonary parenchyma. Microvessel density was significantly greater in these patients than in age-matched controls (P =.01). Immunohistochemistry demonstrated uniform staining for type IV collagen and alpha-smooth muscle actin, weak staining for the endothelial marker CD31 (cluster of differentiation, PECAM-1), and negative staining for proliferating cell nuclear antigen. Electron microscopy revealed endothelial irregularity, a disorganized basement membrane, and increased numbers of collagen and actin filaments beneath the endothelium.
  
  
  CONCLUSIONS
  This study represents an attempt to characterize the histologic features of pulmonary arteriovenous malformations in children with congenital heart disease who have pulmonary arterial blood flow devoid of hepatic venous effluent. The histologic correlate of this condition appears to be greatly increased numbers of thin-walled vessels. Immunohistochemistry suggests that the rate of cellular proliferation is not increased in these lesions. The development of these techniques may provide a standardized histologic approach for this condition and aid in understanding its etiology.
authors.affiliation: Divisions of Cardiac Surgery and Cardiology, Children's Hospital and Regional Medical Center, Seattle, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Duncan
authors.forename: J M
authors.initials: JM
authors.lastname: Kneebone
authors.forename: E Y
authors.initials: EY
authors.lastname: Chi
authors.forename: V
authors.initials: V
authors.lastname: Hraska
authors.forename: F F
authors.initials: FF
authors.lastname: Isik
authors.forename: G L
authors.initials: GL
authors.lastname: Rosenthal
authors.forename: T K
authors.initials: TK
authors.lastname: Jones
authors.forename: S L
authors.initials: SL
authors.lastname: Starnes
authors.forename: F M
authors.initials: FM
authors.lastname: Lupinetti
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D000792:Angiography; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D001706:Biopsy; D002196:Capillaries / Q000000981:diagnostic imaging / Q000648:ultrastructure; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000150:complications* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008168:Lung / Q000098:blood supply / Q000648:ultrastructure; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000473:pathology; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000473:pathology; D014683:Vena Cava, Superior / Q000601:surgery