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Related Experiment Videos

Large pulmonary arteriovenous fistula.

M Ninomiya1, H Makuuchi, Y Naruse

  • 1Department of Cardiovascular Surgery, Toranomon Hospital, Tokyo, Japan.

The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|August 10, 2000
PubMed
Summary

Surgical resection of a giant pulmonary arteriovenous fistula in Rendu-Osler-Weber disease was successfully managed using cardiopulmonary bypass. This technique allowed safe closure of vessels within the fistula, preserving lung function.

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Area of Science:

  • Cardiovascular Surgery
  • Pulmonary Medicine
  • Medical Genetics

Background:

  • Rendu-Osler-Weber disease is a genetic disorder causing abnormal blood vessel formation.
  • Pulmonary arteriovenous fistulas (PAVs) are a potential complication, posing risks of hemorrhage and stroke.
  • Surgical resection is the primary treatment for symptomatic PAVs.

Observation:

  • A 55-year-old woman with Rendu-Osler-Weber disease presented with a giant pulmonary arteriovenous fistula (10 x 6 x 5 cm).
  • Median sternotomy provided initial exposure, but extensive bleeding complicated dissection of feeding and draining vessels.
  • Total cardiopulmonary bypass was initiated to manage intraoperative hemorrhage and facilitate dissection.

Findings:

  • Cardiopulmonary bypass enabled clear delineation of the fistula's anatomy and its feeding/draining vessels.

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  • Vessels were safely suture-closed from within the fistula, avoiding damage to the right middle lobe vein.
  • The patient experienced an uneventful postoperative recovery without cardiopulmonary bypass-related complications.

    • Implications:

    • Cardiopulmonary bypass is a valuable strategy for managing giant pulmonary arteriovenous fistulas when standard dissection is hazardous.
    • This approach ensures safe surgical intervention while preserving vital vascular structures and lung parenchyma.
    • Successful management of this largest-reported fistula highlights the efficacy of cardiopulmonary bypass in complex thoracic cases.