Joseph J. Vettukattil* Pages 244 - 250 ( 7 )
Background: The “hepatic factor,” a molecule or group of molecules present in the hepatic venous blood, essential for the prevention of the development of pulmonary arteriovenous malformations (PAVMs) and right-to-left shunting has been a conceptual enigma in the understanding of many related conditions.Methods: Patients with various forms of liver diseases including acute hepatic failure, and others with normal hepatic function like hereditary hemorrhagic telangiectasia (HHT), inflammatory and parasitic disorders, cardiogenic hepatopulmonary syndrome (cHPS) and skin disorders like Dyskeratosis congenita are all known to cause PAVMs. Over a period of the last two decades our understanding of the pathogenesis of PAVMs has changed, but the mechanisms are still not clearly understood. The presence of PAVMs once considered a contraindication for liver transplantation is now a cure for PAVMs in patients with HPS. Results: In this article the molecular mechanisms and the underlying pathogenesis of PAVMs are discussed and the role of microRNA (miRNA) in its pathogenesis is favorably argued. Identifying and preventing or treating the underlying mechanisms will significantly influence the management of a large group of patients who at present cannot be effectively treated with a very poor prognosis. Progressive polycythemia, desaturation, stroke, and infection are serious complications of PAVMs. Conclusion: The clinical data and current understanding leads to the possible role of miRNA, which inhibits Vascular Endothelial Growth Factor (VEGF) synthesis as a pathogenic mechanism for the development of PAVMs.
Endoglin, hepatic factor, hepatopulmonary syndrome, hereditary hemorrhagic telangiectasia, miRNA, pulmonary arteriovenous malformations, vascular endothelial growth factor.
Congenital Heart Center, Helen DeVos Children's Hospital, 100 Michigan NE (MC248), Grand Rapids, MI 49503