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Is there a reversal of pulmonary arteriovenous malformation after redirection of anomalous hepatic venous flow to the lungs?

Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, and Heart Institute, Schneider Children's Medical Center of Israel, Petah Tiqva, both affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

*Corresponding author. Tel.: +972-3-937-6701; fax: +972-3-924-0762.

E-mail address: georgios{at}clalit.org.il (G.P. Georghiou).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether pulmonary arteriovenous malformation resolves after redirection of the anomalous hepatic venous flow to the lungs. Altogether 714 papers were found using the reported search, of which only 13 papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type and relevant outcomes of these papers are tabulated. We conclude that the exclusion of hepatic venous blood from the lungs can predispose the patient to intrapulmonary shunt, which can be reversed surgically by diverting the hepatic venous drainage to the right atrium.

Key Words: Evidence-based medicine; Hypoxemia; Right-to-left shunt; Anomalous venous drainage; Review