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Normal and abnormal pulmonary arteriovenous shunting: occurrence and mechanisms

Published online by Cambridge University Press:  05 March 2013

Julien I.E. Hoffman
Julien I.E. Hoffman*
Affiliation:
Department of Pediatrics, University of California, San Francisco, CA, United States of America
*
Correspondence to: Professor J.I.E. Hoffman, BS Hons (Wits), MD (Wits), 925 Tiburon Boulevard, Tiburon, CA 94920-1525. Tel: 415-435-6941; Fax: 415-435-6941; E-mail: [email protected]
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Abstract

Severe cyanosis due to pulmonary arteriovenous fistulas occurs often after a bidirectional superior cavopulmonary anastomosis (Glenn operation) and also in some congenital anomalies in which hepatic venous blood bypasses the lungs in the first passage. Relocation of hepatic flow into the lungs usually causes these fistulas to disappear. Similar pulmonary arteriovenous fistulas are observed in hereditary haemorrhagic telangiectasia, and in liver disease (hepatopulmonary syndrome). There is no convincing identification yet of a responsible hepatic factor that produces these lesions. Candidates for such a factor are reviewed, and the possibility of angiotensin or bradykinin contributing to the fistulas is discussed.

Keywords

Cavopulmonary anastomosishepatopulmonary syndromeangiogenesishepatic venous flowpulmonary arteriovenous fistulas
Type
Review Articles
Information
Cardiology in the Young , Volume 23 , Issue 5 , October 2013 , pp. 629 - 641
Copyright
Copyright © Cambridge University Press 2013 

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