HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Viktor Hraska Thomas K. Jones Flavian M. Lupinetti Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Duncan, B. W. Articles by Lupinetti, F. M. Search for Related Content PubMed PubMed Citation Articles by Duncan, B. W. Articles by Lupinetti, F. M.

J Thorac Cardiovasc Surg 1999;117:931-938
© 1999 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

A DETAILED HISTOLOGIC ANALYSIS OF PULMONARY ARTERIOVENOUS MALFORMATIONS IN CHILDREN WITH CYANOTIC CONGENITAL HEART DISEASE

From the Divisions of Cardiac Surgery^a and Cardiology,^e Children's Hospital and Regional Medical Center, Seattle; the Departments of Pathology^b and Surgery,^d University of Washington, Seattle, Wash; and the Department of Cardiovascular Surgery,^c The Children's Hospital, Bratislava, Slovakia.

Received for publication Aug 17, 1998. Revisions requested Oct 30, 1998. Revisions received Dec 29, 1998. Accepted for publication Jan 13, 1999. Address for reprints: Brian W. Duncan, MD, Division of Cardiac Surgery, Children's Hospital and Regional Medical Center, 4800 Sand Point Way, NE, PO Box 5371/CM-03, Seattle, WA 98105.

Introduction: Pulmonary arteriovenous malformations are a common cause of progressive cyanosis in children after cavopulmonary anastomoses. We analyzed the pulmonary histologic characteristics from children in whom pulmonary arteriovenous malformations developed after procedures that resulted in pulmonary arterial blood flow devoid of hepatic venous effluent.
Methods: We performed routine histologic studies, immunohistochemical staining, and electron microscopic analysis of peripheral lung biopsy specimens from 2 children with angiographically proven pulmonary arteriovenous malformations. Microvessel density was determined with a computer-assisted, morphometric analysis system.
Results: Histologic examination demonstrated large, dilated blood vessels (“lakes”) and clustered, smaller vessels (“chains”) in the pulmonary parenchyma. Microvessel density was significantly greater in these patients than in age-matched controls (P = .01). Immunohistochemistry demonstrated uniform staining for type IV collagen and -smooth muscle actin, weak staining for the endothelial marker CD31 (cluster of differentiation, PECAM-1), and negative staining for proliferating cell nuclear antigen. Electron microscopy revealed endothelial irregularity, a disorganized basement membrane, and increased numbers of collagen and actin filaments beneath the endothelium.
Conclusions: This study represents an attempt to characterize the histologic features of pulmonary arteriovenous malformations in children with congenital heart disease who have pulmonary arterial blood flow devoid of hepatic venous effluent. The histologic correlate of this condition appears to be greatly increased numbers of thin-walled vessels. Immunohistochemistry suggests that the rate of cellular proliferation is not increased in these lesions. The development of these techniques may provide a standardized histologic approach for this condition and aid in understanding its etiology.

This article has been cited by other articles:

				J. S. Tweddell Invited commentary. Ann. Thorac. Surg., February 1, 2009; 87(2): 553 - 554. [Full Text] [PDF]

				R. S. Tipps, M. Mumtaz, P. Leahy, and B. W. Duncan Gene array analysis of a rat model of pulmonary arteriovenous malformations after superior cavopulmonary anastomosis. J. Thorac. Cardiovasc. Surg., August 1, 2008; 136(2): 283 - 289. [Abstract] [Full Text] [PDF]

				G. E. Urcelay, A. J. Borzutzky, P. A. Becker, and M. E. Castillo Nitric Oxide in Pulmonary Arteriovenous Malformations and Fontan Procedure Ann. Thorac. Surg., July 1, 2005; 80(1): 338 - 340. [Abstract] [Full Text] [PDF]

				G. P. Georghiou, E. Birk, and B. A. Vidne Is there a reversal of pulmonary arteriovenous malformation after redirection of anomalous hepatic venous flow to the lungs? Interactive CardioVascular and Thoracic Surgery, June 1, 2005; 4(3): 227 - 231. [Abstract] [Full Text] [PDF]

				M. A. Mumtaz, C. H. Fraga, C. M. Nicholls, S. Desai, N. Vasilyev, R. Joshi, R. B.B. Mee, and B. W. Duncan Increased expression of vascular endothelial growth factor messenger RNA in lungs of rats after cavopulmonary anastomosis J. Thorac. Cardiovasc. Surg., January 1, 2005; 129(1): 209 - 210. [Full Text] [PDF]

				A. Ikai, R. K. Riemer, X. Ma, O. Reinhartz, F. L. Hanley, and V. M. Reddy Pulmonary expression of the hepatocyte growth factor receptor c-Met shifts from medial to intimal layer after cavopulmonary anastomosis J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1442 - 1449. [Abstract] [Full Text] [PDF]

				A. Ikai, M. Shirai, K. Nishimura, T. Ikeda, T. Kameyama, K. Ueyama, and M. Komeda Hypoxic pulmonary vasoconstriction disappears in a rabbit model of cavopulmonary shunt J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1450 - 1457. [Abstract] [Full Text] [PDF]

				I. Friehs and P. J. del Nido Invited commentary Ann. Thorac. Surg., February 1, 2004; 77(2): 463 - 463. [Full Text] [PDF]

				A. Dodge-Khatami, N. Sreeram, B.A.J.M. de Mol, and G.B.W.E. Bennink Systemic plasma vascular endothelial growth factor levels as a marker for increased angiogenesis during the single ventricle surgical pathway Interactive CardioVascular and Thoracic Surgery, December 1, 2003; 2(4): 458 - 461. [Abstract] [Full Text] [PDF]

				B. W. Duncan and S. Desai Pulmonary arteriovenous malformations after cavopulmonary anastomosis Ann. Thorac. Surg., November 1, 2003; 76(5): 1759 - 1766. [Abstract] [Full Text] [PDF]

				M. Ono, Y. Sawa, K. Matsumoto, T. Nakamura, Y. Kaneda, and H. Matsuda In Vivo Gene Transfection With Hepatocyte Growth Factor via the Pulmonary Artery Induces Angiogenesis in the Rat Lung Circulation, September 24, 2002; 106(12_suppl_1): I-264 - I-269. [Abstract] [Full Text] [PDF]

				S. P. Malhotra, V. M. Reddy, S. Thelitz, Y.-P. He, D. M. McMullan, F. L. Hanley, and R. K. Riemer The role of oxidative stress in the development of pulmonary arteriovenous malformations after cavopulmonary anastomosis J. Thorac. Cardiovasc. Surg., September 1, 2002; 124(3): 479 - 485. [Abstract] [Full Text] [PDF]

				J. M. Chu, Q. Y. Wu, and W. M. Wang Pulmonary Blood Distribution After Total Cavopulmonary Connection Asian Cardiovasc Thorac Ann, December 1, 2001; 9(4): 282 - 285. [Abstract] [Full Text] [PDF]

				S. P. Malhotra, R. K. Riemer, S. Thelitz, Y.-P. He, F. L. Hanley, and V. M. Reddy Superior cavopulmonary anastomosis suppresses the activity and expression of pulmonary angiotensin-converting enzyme J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 464 - 469. [Abstract] [Full Text] [PDF]

				S. L. Starnes, B. W. Duncan, J. M. Kneebone, G. L. Rosenthal, K. Patterson, C. H. Fraga, K. M. Kilian, S. K. Mathur, and F. M. Lupinetti Angiogenic proteins in the lungs of children after cavopulmonary anastomosis J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 518 - 523. [Abstract] [Full Text] [PDF]

				S. L. Starnes, B. W. Duncan, J. M. Kneebone, C. H. Fraga, S. States, G. L. Rosenthal, and F. M. Lupinetti Pulmonary microvessel density is a marker of angiogenesis in children after cavopulmonary anastomosis J. Thorac. Cardiovasc. Surg., November 1, 2000; 120(5): 902 - 908. [Abstract] [Full Text] [PDF]

				P. G. Walker, T. T. Howe, R. L. Davies, J. Fisher, and K. G. Watterson Distribution of hepatic venous blood in the total cavo-pulmonary connection: an in vitro study Eur. J. Cardiothorac. Surg., June 1, 2000; 17(6): 658 - 665. [Abstract] [Full Text] [PDF]

				M J KROWKA Hepatopulmonary syndromes Gut, January 1, 2000; 46(1): 1 - 4. [Full Text] [PDF]