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Updated: Jun 12, 2026
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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Venovenous malformation: a common finding after Kawashima operation
Alaa-Basiouni S Mahmoud1, Salem Zahrani, Saud A Bahaidarah
1Division of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. alaabasiouni@hotmail.com
Summary
Systemic venovenous malformations (VVM) frequently occur after the Kawashima operation in patients with congenital heart disease, leading to significant desaturation. Early angiographic assessment is recommended to evaluate these VVM and guide management.
Area of Science:
- Cardiology
- Pediatric Surgery
- Vascular Malformations
Background:
- Systemic venovenous malformations (VVM) are a known complication in patients with interrupted inferior vena cava (IVC) and univentricular heart disease undergoing the Kawashima operation.
- These VVM can result in significant postoperative systemic desaturation.
Purpose of the Study:
- To characterize the prevalence, anatomical details, and clinical correlations of systemic VVM following the Kawashima operation.
- To discuss the evaluation and postoperative management of these malformations.
Main Methods:
- Prospective postoperative angiography was performed on eight patients (median age 19 months) who underwent the Kawashima operation.
- The origin, entry sites, and course of VVM were documented.
- The presence of concomitant pulmonary arteriovenous malformations (AVMs) was also assessed.
Main Results:
- Systemic VVM were identified in 75% of patients (six out of eight) at a median follow-up of 31 months.
- A total of 14 VVM were found in various supra- and infra-diaphragmatic locations.
- Four patients had concurrent pulmonary AVMs, and two had pulmonary AVMs only.
Conclusions:
- Systemic VVM are a frequent occurrence after the Kawashima operation and can cause significant postoperative desaturation.
- Hepatic incorporation is supported as a management strategy.
- Routine preoperative detailed angiographic assessment of systemic veins is likely warranted.
