title: Off-pump hepatic to azygos connection via thoracotomy for relief of fistulas after a Kawashima procedure: Ten-year results.
abstract: OBJECTIVE
  An almost universal incidence of developing pulmonary arteriovenous fistulas after the Kawashima operation has been reported. Exclusion of the hepatic venous flow from the pulmonary circulation causes the development of these malformations. Redirection of hepatic venous flow to the pulmonary circulation mostly leads to the regression of the arteriovenous fistulas.
  
  
  METHODS
  We analyzed 11 patients with arteriovenous fistulas that developed after the Kawashima operation. The hepatic-to-azygos shunts were performed with an off-pump technique through a lateral thoracotomy in all but one. Operative and postoperative data were retrospectively collected.
  
  
  RESULTS
  No intraoperative complications occurred, and no patient died in the hospital. Up to 10-year follow-up showed a significant postoperative improvement of patients' oxygen saturation and New York Heart Association class. Apart from 2 re-thoracotomies for bleeding in 1 patient, no complications occurred and no patient died during follow-up. Two other patients underwent reoperation for an undiagnosed additional hepatic vein. The improvement of patients' oxygen saturation and New York Heart Association class persisted during the follow-up period.
  
  
  CONCLUSIONS
  The surgical connection can be performed safely with an off-pump technique that avoids the risks related to extracorporeal circulation and circulatory arrest. The results at 10 years follow-up confirmed the efficacy and safety of the surgical technique described.
authors: Department of Congenital Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands. Electronic address: s.c.arrigoni@umcg.nl.
authors: Sara C
authors: SC
authors: Arrigoni
authors: Department of Pediatric Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors: Freek
authors: F
authors: van den Heuvel
authors: Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors: Tineke P
authors: TP
authors: Willems
authors: Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors: Hans
authors: H
authors: Hillege
authors: Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital, Oslo, Norway.
authors: Harald L
authors: HL
authors: Lindberg
authors: Department of Pediatric Cardiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors: Rolf M F
authors: RM
authors: Berger
authors: Department of Congenital Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
authors: Tjark
authors: T
authors: Ebels
mesh_terms: D000293:Adolescent; D000328:Adult; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001401:Azygos Vein / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right / Q000009:adverse effects* / Q000379:methods; D006330:Heart Defects, Congenital / Q000601:surgery*; D006503:Hepatic Veins / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Fontan procedure; collateral circulation; congenital heart defect; thoracotomy