Anesthetic Management for Resection of a Pulmonary Arteriovenous Malformation.

Roh,  Woon Seok; Song,  Seok Young; Park,  Chan Hong; Kim,  Bong Il; Cho,  Soung Kyung; Lee,  Sang Hwa; Lee,  Sub; Ahn,  Wook Su

doi:2001.40.1.100

Clinical Research Article

Korean Journal of Anesthesiology 2001;40(1):100-105.
DOI: https://doi.org/10.4097/kjae.2001.40.1.100

Anesthetic Management for Resection of a Pulmonary Arteriovenous Malformation.

Woon Seok Roh, Seok Young Song, Chan Hong Park, Bong Il Kim, Soung Kyung Cho, Sang Hwa Lee, Sub Lee, Wook Su Ahn

¹Department of Anesthesiology, School of Medicine, Taegu Catholic University, Taegu, Korea.
²Department of Thoracic and Cardiovascular Surgery, School of Medicine, Taegu Catholic University, Taegu, Korea.

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.

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