Background A high incidence of pulmonary arteriovenous fistulas (PAVF) has
been reported after bidirectional cavopulmonary shunt (BCPS) or total cavop
ulmonary shunt (TCPS; BCPS in patients with interrupted inferior vena cava)
. However, the definite diagnostic criteria or standard diagnostic modality
of PAVF has not yet been defined. The goal of this study was to evaluate t
he diagnostic modalities and the prevalence of PAVF.
Methods. We selected 10 patients with TCPS and 27 patients with BCPS. Lung
perfusion scan, contrast echocardiogram, and pulmonary angiogram were perfo
rmed. The results were compared among groups of patients and among each dia
gnostic modality.
Results. All 10 patients with TCPS and 16 and 13 patients with BCPS showed
positive results on contrast echocardiograms and lung scans, respectively.
Six patients with TCPS and 4 patients with BCPS showed positive results on
pulmonary angiograms. All patients with TCPS developed subclinical or clini
cal PAVF and 19 patients with BCPS developed subclinical PAVF and none of t
hem had clinical PAVF during the short-term follow-up.
Conclusions. Most patients with bidirectional cavopulmonary anastomosis hav
e subclinical evidence of right-to-left intrapulmonary shunting. This probl
em can be demonstrated with various diagnostic modalities. (Ann Thorac Surg
2000;70:1918-22) (C) 2000 by The Society of Thoracic Surgeons.