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Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome

BACKGROUND: Pulmonary arteriovenous malformations (PAVMs) are the major cause of progressive cyanosis in patients palliated with bidirectional cavopulmonary connection (BCPC). The aim of our study is to analyze the occurrence of PAVMs in patients after Kawashima procedure, to study the effect of tot...

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Autores principales: Alibrahim, Ibrahim J., Mohammed, Mohammed H. A., Kabbani, Mohamad S., Jijeh, Abdulraouf M. Z., Tamimi, Omar R., Alghamdi, Abdullah A., Alhabshan, Fahad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918011/
https://www.ncbi.nlm.nih.gov/pubmed/33679056
http://dx.doi.org/10.4103/apc.APC_144_19
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author Alibrahim, Ibrahim J.
Mohammed, Mohammed H. A.
Kabbani, Mohamad S.
Jijeh, Abdulraouf M. Z.
Tamimi, Omar R.
Alghamdi, Abdullah A.
Alhabshan, Fahad
author_facet Alibrahim, Ibrahim J.
Mohammed, Mohammed H. A.
Kabbani, Mohamad S.
Jijeh, Abdulraouf M. Z.
Tamimi, Omar R.
Alghamdi, Abdullah A.
Alhabshan, Fahad
author_sort Alibrahim, Ibrahim J.
collection PubMed
description BACKGROUND: Pulmonary arteriovenous malformations (PAVMs) are the major cause of progressive cyanosis in patients palliated with bidirectional cavopulmonary connection (BCPC). The aim of our study is to analyze the occurrence of PAVMs in patients after Kawashima procedure, to study the effect of total cavopulmonary connection (TCPC) on PAVMs, to evaluate the effect of axillary arteriovenous fistula (AAVF) creation on PAVMs, and to study the risk factors for PAVMs. METHODS: In this retrospective cohort study, all patients with left isomerism and azygous continuation of an interrupted inferior vena cava who underwent Kawashima procedure from July 2001 to December 2017 were included. RESULTS: Twenty.six patients after Kawashima procedure were included in our study. PAVMs were diagnosed in 12 patients (46%). Five of these 12 patients underwent TCPC with complete resolution of hypoxemia. Three patients underwent AAVF creation, 2 had complete resolution, while 1 had partial resolution of hypoxemia. Fourteen patients (54%) did not develop PAVMs. Nakata index below 267 mm(2)/m(2)and McGoon ratio below 1.9 predicted the development of PAVMs with high sensitivity and specificity. CONCLUSIONS: PAVMs represent a serious complication in patients who undergo Kawashima procedure. Small size of pulmonary arteries is an important risk factor for the development of PAVMs. Resolution of hypoxemia after TCPC completion supports the hepatic factor hypothesis. Early TCPC completion in these patients may help to avoid the development of PAVMs by restoring the hepatic factor. Resolution of hypoxemia after AAVF creation may support the lack of pulsatile flow hypothesis.
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spelling pubmed-79180112021-03-05 Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome Alibrahim, Ibrahim J. Mohammed, Mohammed H. A. Kabbani, Mohamad S. Jijeh, Abdulraouf M. Z. Tamimi, Omar R. Alghamdi, Abdullah A. Alhabshan, Fahad Ann Pediatr Cardiol Original Article BACKGROUND: Pulmonary arteriovenous malformations (PAVMs) are the major cause of progressive cyanosis in patients palliated with bidirectional cavopulmonary connection (BCPC). The aim of our study is to analyze the occurrence of PAVMs in patients after Kawashima procedure, to study the effect of total cavopulmonary connection (TCPC) on PAVMs, to evaluate the effect of axillary arteriovenous fistula (AAVF) creation on PAVMs, and to study the risk factors for PAVMs. METHODS: In this retrospective cohort study, all patients with left isomerism and azygous continuation of an interrupted inferior vena cava who underwent Kawashima procedure from July 2001 to December 2017 were included. RESULTS: Twenty.six patients after Kawashima procedure were included in our study. PAVMs were diagnosed in 12 patients (46%). Five of these 12 patients underwent TCPC with complete resolution of hypoxemia. Three patients underwent AAVF creation, 2 had complete resolution, while 1 had partial resolution of hypoxemia. Fourteen patients (54%) did not develop PAVMs. Nakata index below 267 mm(2)/m(2)and McGoon ratio below 1.9 predicted the development of PAVMs with high sensitivity and specificity. CONCLUSIONS: PAVMs represent a serious complication in patients who undergo Kawashima procedure. Small size of pulmonary arteries is an important risk factor for the development of PAVMs. Resolution of hypoxemia after TCPC completion supports the hepatic factor hypothesis. Early TCPC completion in these patients may help to avoid the development of PAVMs by restoring the hepatic factor. Resolution of hypoxemia after AAVF creation may support the lack of pulsatile flow hypothesis. Wolters Kluwer - Medknow 2021 2020-09-17 /pmc/articles/PMC7918011/ /pubmed/33679056 http://dx.doi.org/10.4103/apc.APC_144_19 Text en Copyright: © 2020 Annals of Pediatric Cardiology http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Alibrahim, Ibrahim J.
Mohammed, Mohammed H. A.
Kabbani, Mohamad S.
Jijeh, Abdulraouf M. Z.
Tamimi, Omar R.
Alghamdi, Abdullah A.
Alhabshan, Fahad
Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome
title Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome
title_full Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome
title_fullStr Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome
title_full_unstemmed Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome
title_short Pulmonary arteriovenous malformations in children after the Kawashima procedure: Risk factors and midterm outcome
title_sort pulmonary arteriovenous malformations in children after the kawashima procedure: risk factors and midterm outcome
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918011/
https://www.ncbi.nlm.nih.gov/pubmed/33679056
http://dx.doi.org/10.4103/apc.APC_144_19
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