Pulmonary arteriovenous malformation in patients with total cavopulmonary shunt: what role does lack of hepatic venous blood flow to the lungs play?

We examined the etiology of a long-term postoperative complication, pulmonary arteriovenous malformation (PAVM), in a patient who underwent total cavopulmonary shunt (TCPS). The patient underwent TCPS at the age of 3 years and 1 month, and a PAVM developed. At the age of 10 years, TCPS was switched to total cavopulmonary connection to facilitate circulation of hepatic venous blood to the pulmonary artery. As a result, oxygen saturation increased. These findings suggest that the absence of pulmonary circulation of hepatic venous blood is involved in the development of PAVM.