Development of pulmonary arteriovenous fistulas after bidirectional cavopulmonary shunt

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.