Contrast Echocardiography for Diagnosis of Pulmonary Arteriovenous Fistula Late After Glenn Anastomosis

One of the undesirable long term complications of the superior vena cava-pulmonary artery anasıomosis (Glenn shunt) is the formatian of pulmonary arteriovenous fistulae (PA VF). To dernonsırate the use of contrast echocardiography for the detection of PA VF in patients w ith a previous classical or bidirectional Glenn shunt and examine the prevalence of PAVF in this special population, 12 patients aged 21-38 (mean 28±4.8) years were prospectively evaluated by contrast echocardiography 4-33 (mean 24±9) years after the operation. ll patients had cardiac catheterization and angiography, 6 patients had magnetic resonance imaging, the results were compareel with the echocardiographic findings. Contrast echocardiography showeel evielence of PA VF in 7 of the 12 patients, w ith ap pearan ce of echo contrast in the left atrium 1-8 seconds after an upper extremity peripheral venous injection. Simultaneous appearance of microbubbles in the right atrium was due to residual communication betwPen the superior vena cava and the right atrium in 2 patients and presence of C'() Ilaterals between the superior and inferior venae cavae in one. In patients with PAVF, arterial oxygen saturations at rest (51-94 °t , mean 75±15.3 %) and on exercise (23-91%, mean 53±24.2%) were significantly lower compareel to patients without PAVF (p<0.005). Pulmonary hypertension in the contralateral lung was more common in patients with PAVF (mean left pulmonary artery pressure 22-110 mmHg, p=0.014). In patients with cavopulmonary anastomoses, PA VF occur frequently in the long term and are associated with worsening systemic arterial desaturation. Contrast echocardiography should be included in the regular evaluation of these patients as a simple and sensitive technique for the detection of PA VF, particularly when inercasing cyanosis develops.