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Ann Thorac Surg 1997;63:930-932
© 1997 The Society of Thoracic Surgeons
National Cardiovascular Center, Osaka, Japan
| The first 300 words of the full text of this article appear below. |
Pulmonary arteriovenous malformation (PAVM) after Glenn operation initially was considered a consequence of excessive perfusion of the lower lobe. However, after the Fontan as well as the Kreutzer operation, both of which bypass the right ventricle as well, this catastrophic sequela was seldom reported. Although right atrial contraction as a pumping force of blood into the pulmonary circulation had been negated experimentally [1], the presence of pulsation in the pulmonary artery after the Fontan-type operation had been considered the difference between the Glenn operation and the Fontan operation with respect to PAVM development.
The total cavopulmonary shunt (TCPS) operation [2], which my colleagues and I developed and used clinically since 1978 for polysplenic patients with interrupted inferior vena cava and azygos or hemiazygos continuation, brought us excellent early postoperative results as this operation had as one advantage the elimination of any complicated intraatrial procedure to separate the complex systemic and pulmonary venous returns. Soon, however, postoperative development of PAVM was reported as seen after the Glenn operation.
See also page 960.
As the TCPS operation bypasses not only the right ventricle but also the right atrium, there is no pulsation in the pulmonary artery. Therefore, the absence of pulsation in the pulmonary artery was considered one of the reasons for the difference from the Fontan operation. Alternatively, the absence of some putative substance that is found in the hepatic venous blood, and that prohibits the development of PAVM, in the pulmonary artery in patients who underwent the TCPS operation was also speculated as an important reason for the development of PAVM.
De Leval and associates [3] advocated the advantage of a total cavopulmonary connection operation, wherein the inferior vena cava is connected to the pulmonary artery with a composite channel or a prosthetic tube
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Ann. Thorac. Surg. 1997 63: 960-963.
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