title: Reconstruction of cavopulmonary pathway for the patient with persistent arteriovenous malformations due to offset flow from hepatic vein.
abstract: The hypoxemia caused by arteriovenous malformations after cavopulmonary shunt in patients with heterotaxy, an interrupted inferior vena cava and single ventricle physiology have been treated by incorporation of hepatic vein flow into the pulmonary circulation. However, some patients have persistent arteriovenous malformations because of offset hepatic venous flow to one pulmonary artery. Various approaches have been used to change offset flow to achieve balanced hepatic flow to the lungs in this patient population. This case report highlights the challenges that may be associated with anastomosis of the azygos vein to the inferior vena cava at the level of the diaphragm and illustrates an alternative technique to direct hepatic venous blood into an affected lung with arteriovenous malformations. The redirection of hepatic venous flow to the affected pulmonary artery resulted in resolution of symptoms within months of surgery.
authors: Cardiovascular Surgery, Children's National Medical Center, Washington, DC.
authors: Narutoshi
authors: N
authors: Hibino
authors: Pranava
authors: P
authors: Sinha
authors: Mary
authors: M
authors: Donofrio
authors: Richard A
authors: RA
authors: Jonas
keywords: Arteriovenous malformation; Hepatic vein
references: Ann Thorac Surg. 2005 Nov;80(5):1592-6
references: 16242422
references: Ann Thorac Surg. 2001 Nov;72(5):1641-4
references: 11722058
references: Ann Thorac Surg. 2003 May;75(5):1640-2
references: 12735598
references: Cardiol Young. 2008 Jun;18(3):311-5
references: 18405426
references: Ann Thorac Surg. 2005 Nov;80(5):1597-603
references: 16242423
references: World J Pediatr Congenit Heart Surg. 2011 Jan;2(1):119-28
references: 23804943
references: J Thorac Cardiovasc Surg. 2011 Jun;141(6):1362-70.e1
references: 21146835
references: Eur J Cardiothorac Surg. 2002 Mar;21(3):582-4
references: 11888793
references: Am J Physiol Heart Circ Physiol. 2002 Nov;283(5):H2151-6
references: 12384493