The Clinical Diagnosis And Surgical Treatment Of Pulmonary Arteriovenous Fistula

Objective:Pulmonary arteriovenous fistula(PAVF) is a rare geneogenous disease, it is one or more than one abnormal vascellums communicating between pulmonary arteries and veins, or between general circular arteries and pulmonary veins, which makes some blood directly refluxing to the heart not through pulmonary capillaries. The clinical symptoms of patients with PAVF contains hemoptysis, chest distress, thoracodynia, breath lessness, etc al. Moderate or severe patients with PAVF often suffer from varying degrees of cyanosis, apopsychia, achropachy and exertional dyspnea, they even suffer from cerebral infarction, cerebral apoplexy, hemothorax, fatal macrohemoptysis and other complications. The aim of the investigation is to understand of the clinical manifestation, imageology diagnosis and surgical operational therapy through analyzing the clinical cases.Methods:In the investigation, we retrospective analysis and summary the clinical manifestation, diagnostic imaging, surgical therapeutic data of patients with PAVF in hospital during the in December2005and December2010. Results:Pulmonary arteriovenous fistula in the group21patients,15males and6females, aged16-73years, mean31.5years old.12cases in the left lung (11cases in left lower lung,1case in left up lung),9cases in the right lung (7cases in right lower lung,1case in right middle lobe,1case in right upper lobe). The group of single17cases, multiple in4cases, including15cases Of simple type,4cases of complex type,2of diffuse type.12case the left anterolateral incision into the chest, lower lobe resection in9cases, resection of the lower dorsal segment in2case, resection of the upper lung in one case;9cases of the right lateral chest incision into the chest, lower lobe resection in7cases; resection of the middle lung in one case;resection of the upper lung in one case. Before surgery, all patients had varying degrees of dyspnea, weakness, fainting, palpitation after activity, hemoptysis, cyanosis and other symptoms.18patients concomitanced with dyspnea, fatigue, syncope which was significantly reduced compared with the previous,15cases of hemoptysis disappeared;11cases of cyanosis reduced. Preoperative arterial oxygen saturation (SaO2)73%-86%, an average of78%, mean arterial oxygen saturation compared with that before rose to85%. Follow-up has no symptoms or recurrence.Conclusion:Multi-slice spiral CT and the application of various kinds of reconstruction technique are reliable and safe inspection method for diagnosis and differential diagnosis of PAVF. Meanwhile, surgical therapy is an effective radical treatment for simple type (more than2.0mm in diameter), complex type, patients with or without clinical symptoms..