Pulmonary arteriovenous malformations after cavopulmonary anastomosis

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Pulmonary arteriovenous malformations after cavopulmonary anastomosis Brian W Duncan, MD, Shailesh Desai, PhD The Annals of Thoracic Surgery Volume 76, Issue 5, Pages 1759-1766 (November 2003) DOI: 10.1016/S0003-4975(03)00450-8

Fig 1 Selective injection of the right lower lobe pulmonary artery in a patient with diffuse pulmonary arteriovenous malformations after a total cavopulmonary shunt (Kawashima procedure). Rapid filling of the pulmonary vein (arrow) is seen in the capillary phase of the injection. (Reprinted from Duncan BW, et al. J Thorac Cardiovasc Surg; 1999;117:931–8 [15]; with permission.) The Annals of Thoracic Surgery 2003 76, 1759-1766DOI: (10.1016/S0003-4975(03)00450-8)

Fig 2 Micrographs of a lung biopsy specimen from a patient with pulmonary arteriovenous malformations. (A) Origin of pulmonary arteriovenous malformation lake (arrows) branching from pulmonary arteriole (BV). Edema (ED) of the pulmonary parenchyma is evident in a perivascular location. (B) Pulmonary arteriovenous malformation chains (BV and *) surrounding an airway (AW) with thin walls demonstrating incomplete elastin staining (arrows) (Movat’s pentachrome, original magnification × 200). (Reprinted from Duncan BW, et al. J Thorac Cardiovasc Surg; 1999;117:931–8 [15]; with permission.) The Annals of Thoracic Surgery 2003 76, 1759-1766DOI: (10.1016/S0003-4975(03)00450-8)

Fig 3 Diagram of the role of the liver in the development of pulmonary arteriovenous malformations (PAVM) after cavopulmonary anastomosis. (VEGF = vascular endothelial growth factor.) The Annals of Thoracic Surgery 2003 76, 1759-1766DOI: (10.1016/S0003-4975(03)00450-8)

Fig 4 Mean microvessel density per high-power field in patients after cavopulmonary anastomosis with clinically evident pulmonary arteriovenous malformations (PAVM), without clinical evidence of PAVM (Asymptomatic Post–CPA [cavopulmonary anastomosis]) and controls. Error bars represent standard deviation. (Reprinted from Starnes SL, et al. J Thorac Cardiovasc Surg; 2000;120:902–7 [34]; with permission.) The Annals of Thoracic Surgery 2003 76, 1759-1766DOI: (10.1016/S0003-4975(03)00450-8)

Fig 5 Mean microvessel density in the lung ipsilateral to the cavopulmonary anastomosis (unshaded bars) versus control lung (shaded bars) for animals at each time point from 2 to 13 months, postoperatively. Error bars represent the standard deviation of the mean. (Reprinted from Starnes SL, et al. Am J Physiol; 2002;283:H2151–5 [52]; with permission.) The Annals of Thoracic Surgery 2003 76, 1759-1766DOI: (10.1016/S0003-4975(03)00450-8)

Fig 6 Linear regression analysis of the ratio of the average number of vessels positive for von Willebrand factor from 10 high-powered fields from shunted lung/average number of vessels positive for von Willebrand factor in 10 high-powered fields from control lung on time after cavopulmonary anastomosis. (Reprinted from Starnes SL, et al. Am J Physiol; 2002;283: H2151–5 [52]; with permission.) The Annals of Thoracic Surgery 2003 76, 1759-1766DOI: (10.1016/S0003-4975(03)00450-8)