PULMONARY AND SYSTEMIC ARTERIOVENOUS-FISTULAS IN PATIENTS WITH LEFT ISOMERISM

Hepatic venous blood has been thought to play some role as a vasoactiv e agent in the development of pulmonary arteriovenous fistulas in pati ents with congenital heart disease. During the last 15 years, we have observed pulmonary arteriovenous fistulas in 3, and systemic arteriove nous fistulas in 2, patients from our 16 cases of left isomerism. Duri ng the same period, neither pulmonary nor systemic arteriovenous fistu las were detected among 50 patients with right isomerism. Pulmonary ar teriovenous fistulas had developed in the absence of surgery in I of t he patients. Both pulmonary and systemic fistulas were detected in an another patient, in whom the hepatic venous blood bypassed the pulmona ry circulation. The level of somatostatin, which is known to reduce sp lanchnic blood flow was high in the systemic venous blood of this pati ent. Although the mechanism of development of the fistulas has yet to be clarified, we should be aware that not only pulmonary, but also sys temic arteriovenous fistulas can be found in patients with left isomer ism, even prior to any surgical intervention.