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Ann Thorac Surg 1999;68:233
© 1999 The Society of Thoracic Surgeons

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Invited Commentaries

^a Department of Cardiovascular Surgery, Children’s Hospital, 300 Longwood Ave, Boston, MA, USA 02115

Invited commentary

The case report by Baskett and colleagues provides additional support for the role of factors in hepatic venous blood in the development of pulmonary arteriovenous malformation [1]. In their case, diversion of hepatic venous blood into the azygous vein in a patient with interrupted inferior vena cava with azygous continuation and a prior bidirectional cavopulmonary shunt, led to resolution of desaturation due to pulmonary arteriovenous malformations over several months. Their results parallel those of our own group and of others [2, 3].

The techniques described by the authors of connecting the hepatic veins directly to the side of the azygous vein is unique, in that it avoids the technically simpler use of an extra-cardiac conduit or construction of an intra-atrial lateral tunnel. The need for deep hypothermia and circulatory arrest, to accomplish this procedure, would seem to be a drawback. However, the technique does avoid the use of the prosthetic tube grafts and the potentially arrhythmogenic atrial incisions and suture lines necessary to create a lateral tunnel-type Fontan procedure. Longer follow-up of lateral tunnel and extra-cardiac conduit Fontan procedures will be necessary before decisions can be made about the relative advantages and disadvantages of the author’s technique versus extra-cardiac or lateral tunnel techniques.

References

1. Srivistava D., Preminger T., Lock J.E., et al. Hepatic venous blood and the development of pulmonary ateriovenous malformations in congenital heart disease. Circulation 1995;92:1217-1222.[Abstract/Free Full Text]
2. Kreutzer J., Castañeda A.R., Keane J.F., Mayer J.E., Jr, Jonas R.A., Lock J.E. Surgical incorporation of hepatic veins in patients with pulmonary arteriovenous malformations (AVMs) after Kawashima operation. Cardiology in the Young 1997;7:125.
3. Shah M.J., Rychik J., Fogel M.A., Murphy J.O., Jacobs M.L. Pulmonary AV malformations after superior cavopulmonary connection. Ann Thorac Surg 1997;63:960-963.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John E. Mayer, Jr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mayer, J. E. Search for Related Content PubMed Articles by Mayer, J. E., Jr Related Collections Related Article