Skip to main content Accessibility help

Off-pump connection of the hepatic to the azygos vein through a lateral thoracotomy for relief of arterio-venous fistulas after a Kawashima procedure

  • Fatima E.F.G. Lopez (a1), Freek van den Heuvel (a1), Petronella G. Pieper (a1), Tjalling W. Waterbolk (a1) and Tjark Ebels (a1)...



To connect the hepatic veins to the azygos venous system through a lateral thoracotomy, and without the use of extracorporeal circulation, so as to relieve arteriovenous fistulas after a previous Kawashima operation.


Description of the operative technique by which the hepatic veins are anastomosed to the hepatic venous system.


The surgical approach was successfully applied in 3 patients, all of whom showed an excellent rise of saturations of oxygen after redirection of the hepatic venous blood.


The operative method presented is an elegant means of redirecting the hepatic venous blood to the pulmonary circulation without the disadvantages of extracorporeal circulation and resternotomy.


Corresponding author

Correspondence to: T. Ebels MD, Ph, Department Cardiothoracic Surgery, University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands. Tel: +31-503613238; Fax: +31-503611347; E-mail:


Hide All
1.Baskett, RJ, Ross, DB, Warren, AE, Sharratt, GP, Murphy, DA. Hepatic vein to the azygous vein anastomosis for pulmonary arteriovenous fistulae. Ann Thor Surg 1999; 68: 232233.
2.Kaneko, Y, Murakami, A, Miyamoto, T, Takamoto, S. Hepatic vein-to-azygos vein connection in a patient with interrupted inferior vena cava. Eur J Cardiothorac Surg 2002; 21: 582584.
3.Uemura, H, Yagihara, T, Hattori, R, Kawahira, Y, Tsukano, S, Watanabe, K. Redirection of hepatic venous drainage after total cavopulmonary shunt in left isomerism. Ann Thorac Surg 1999; 68: 17311735.
4.Kawashima, Y, Kitamura, S, Matsuda, H, Shimazaki, Y, Nakano, S, Hirose, H. Total cavopulmonary shunt operation in complex cardiac anomalies. A new operation. J Thorac Cardiovasc Surg 1984; 87: 7481.
5.Srivastava, D, Preminger, T, Lock, JE, et al. Hepatic venous blood and the development of pulmonary arteriovenous malformations in congenital heart disease. Circulation 1995; 92: 12171222.
6.Duncan, BW, Desai, S. Pulmonary arteriovenous malformations after cavopulmonary anastomosis. Ann Thorac Surg 2003; 76: 17591766.
7.Shah, MJ, Rychik, J, Fogel, MA, Murphy, JD, Jacobs, ML. Pulmonary AV malformations after superior cavopulmonary connection: resolution after inclusion of hepatic veins in the pulmonary circulation. Ann Thorac Surg 1997; 63: 960963.
8.Konstantinov, IE, Puga, FJ, Alexi-Meskishvili, VV. Thrombosis of intracardiac or extracardiac conduits after modified Fontan operation in patients with azygous continuation of the inferior vena cava. Ann Thorac Surg 2001; 72: 16411644.
9.Amodeo, A, Di Carlo, D, Grigioni, M, De Santis, M, Di Donato, RM. Early primary Kawashima operation combined with direct hepatic vein-to-azygos vein connection: A new logical approach. J Thorac Cardiovasc Surg 2005; 129: 949950.
10.Steinberg, J, Alfieris, GM, Brandt, B, et al. New approach to surgical management of pulmonary arteriovenous malformations after cavopulmonary anastomosis. Ann Thor Surg 2003; 75: 16401642.
11.Uemura, H, Ho, SY, Devine, WA, Kilpatrick, LL, Anderson, RH. Atrial appendages and venoatrial connections in hearts from patients with visceral heterotaxy. Ann Thor Surg 1995; 60: 561569.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed