Korean J Anesthesiol.  2001 Jan;40(1):100-105. 10.4097/kjae.2001.40.1.100.

Anesthetic Management for Resection of a Pulmonary Arteriovenous Malformation

• Roh WS
• Song SY
• Park CH
• Kim BI
• Cho SK
• Lee SH
• Lee S
• Ahn WS

• KMID: 2298978
• DOI: http://doi.org/10.4097/kjae.2001.40.1.100

Abstract

Pulmonary arteriovenous malformation (PAVM) is an uncommon congenital anomaly. As PAVM is a direct communication between branches of the pulmonary artery and vein, severe hypoxemia, paradoxical embolism, and massive hemorrhage can result. We present a 39-year-old woman with severe hypoxemia after the induction of one lung ventilation (OLV) for resection of a PAVM in her right lower lobe. We analyzed the cause of hypoxemia by an arterial blood gas analysis and estimated shunt equation. The preoperative value of an intrapulmonary shunt (Qs/Qt) was 15%. However, after the OLV, the values of Qs/Qt increased to 48% with 92.1% arterial oxygen saturation (SaO2). After the resection of PAVM, the value of Qs/Qt decreased to 36% during the OLV, and postoperative value of Qs/Qt and SaO2 were in the normal range. These findings represent that PAVM patients are prone to severe hypoxemia and an abnormally high Qs/Qt, which might be induced by the increase of pulmonary vascular resistance during OLV.

Keyword

Lung: pulmonary arteriovenous malformation; Ventilation: one lung; hypoxemia; intra pulmonary shunt

MeSH Terms

Adult
Anoxia
Arteriovenous Malformations*
Blood Gas Analysis
Embolism, Paradoxical
Female
Hemorrhage
Humans
One-Lung Ventilation
Oxygen
Pulmonary Artery
Reference Values
Vascular Resistance
Veins
Oxygen