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Rossi I, Peixoto AB, de Souza MAR, Araujo Júnior E, Paschoini MC. Intrauterine Diagnosis of Portosystemic Shunt Associated with Trisomy 21. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:101784. [PMID: 34303009 DOI: 10.1016/j.jogc.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Isabela Rossi
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil; Sabin Diagnostic Medicine, Uberaba-MG, Brazil; Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil; Medical course, Municipal University of São Caetano do Sul (USCS), São Paulo-SP, Brazil.
| | - Marina Carvalho Paschoini
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
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Carneiro DN, Rossi I, Oliveira NT, de Moraes Oliveira L, Rodrigues M, Araujo Júnior E, Ruano R, Peixoto AB, Paschoini MC. Congenital intra-hepatic porto-systemic shunts diagnosed during intrauterine life: Systematic review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:803-811. [PMID: 36152014 DOI: 10.1002/jcu.23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/27/2022] [Accepted: 09/03/2022] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe the ultrasonographic characteristics of congenital porto-systemic venous shunts (CPSS) diagnosed during pregnancy, their outcomes, and their evolution. METHODS Two independent researchers selected 493 review articles and case reports through the analysis of titles, abstracts, and full text. The PubMed and LILACS databases were searched. Through the application of filters according to the PRISMA protocol, only six articles were used in the research. The following information was collected, when available: gestational age at diagnosis, gender, birth weight, type of shunt, associated anomalies/complications and treatment/progression. RESULTS The data were obtained from 27 cases, with 22 (82%) fetuses diagnosed with intra-hepatic CPSS and 5 (18%) with extra-hepatic CPSS. The median time of intrauterine diagnosis was 33 weeks. In 12 (57.1%) of the 21 pregnancies evaluated, delivery was preterm. The estimated fetal weight ranged from 1150 to 3760 g, with 4 (25%) cases at <3rd, 3 (18.75%) cases at <10th, 8 (50%) cases at <50th, and 1 (6.25%) case at >97th percentile for gestational age. The most frequent obstetric complication was fetal growth restriction, which occurred in nine (60%) cases. As for postnatal treatment, 19 (70.4%) cases were conservatively treated, and 8 (29.6%) cases required surgical intervention. CONCLUSION The diagnosis of CPSS still represents a challenge during prenatal care. Its early identification aims to provide guidance to pregnant women and their families, as well as follow-up and anticipation of possible complications, in addition to the evaluation of the mode of delivery and postnatal follow-up, directing the short- and long-term prognosis.
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Affiliation(s)
- Darlei Neves Carneiro
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Isabela Rossi
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Nagibe Tayfour Oliveira
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Lorena de Moraes Oliveira
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Mariana Rodrigues
- Department of Radiology and Imaging Diagnostic, Faculty of Medicine of Ribeirão Preto - University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Marina Carvalho Paschoini
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
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Xu L, Zhang H, Liu G, Li Y, Li D, Ma N. Abernethy malformation with unusual cardiac malformation: Case report and literature review. Echocardiography 2023; 40:57-60. [PMID: 36514962 DOI: 10.1111/echo.15504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022] Open
Abstract
Abernethy malformation, also known as congenital extrahepatic shunt, is a rare anomaly, which is characterized by partial or complete diversion of the portal blood into the systemic venous circulation. The clinical manifestations of Abernethy malformation during childhood include neonatal cholestasis, failure to thrive, mental retardation, and other congenital defects. We report a case of Abernethy malformation Type II in a 9-year-old boy, whose left ventricle was slightly enlarged because of several major aortopulmonary collateral arteries (MAPCAs) but laboratory examinations were normal 5 years earlier. The characteristics of congenital heart disease in patients with Abernethy malformation are discussed. We propose that physicians should be aware of the possibility of Abernethy malformation in children with enlargement of the left ventricular due to systemic-pulmonary collateral circulation.
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Affiliation(s)
- Liyuan Xu
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hongju Zhang
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Guowen Liu
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yunpeng Li
- Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Di Li
- Department of Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ning Ma
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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4
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Congenital Absence of the Portal Vein as a Rare Cause of Portopulmonary Hypertension-A Case Study Series. Medicina (B Aires) 2022; 58:medicina58101484. [PMID: 36295644 PMCID: PMC9608572 DOI: 10.3390/medicina58101484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background. Congenital absence of the portal vein (CAPV) is an extremely rare malformation that is caused by aberrant venous development during embryogenesis and is usually associated with congenital portosystemic shunts (CPSS). This hemodynamic allows mesenteric blood to bypass the liver metabolism and causes an imbalance between vasodilators and vasoconstrictors in the pulmonary circulation, which, again, might lead to the development of secondary portopulmonary hypertension (PoPH). Establishing the exact morphology of the splanchnic venous system is important when evaluating possible therapeutic options (differentiating type I and II CAPV), because some variants enable the closure of the shunt, and this represents a potential cure for pulmonary arterial hypertension (PAH). Once PoPH is diagnosed, complex care in a specialized expert centre is necessary. If possible, CPSS closure is recommended. For long-term successful patient management, specific targeted PAH therapy administration is crucial. Significant morbidity and mortality in these patients may result not only from PAH itself but also due to specific PoPH complications, such as compression of the left main coronary artery by pulmonary artery aneurysm. Case Report. We report on two patients with PoPH due to CAPV and CPSS (without any liver disease) who presented as severe PAH and who, before admission to our expert centre, were misdiagnosed as idiopathic PAH. The case reports also represent our experience with respect to the long-term follow-up and PAH-specific medical treatment of these patients, as well as the possible (even fatal) complications of these rare and complex patients.
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Nagy RD, Cernea N, Dijmarescu AL, Manolea MM, Zorilă GL, Drăgușin RC, Vrabie SC, Dîră LM, Sîrbu OC, Novac MB, Drăgoescu NAM, Gheonea M, Stoica GA, Căpitănescu RG, Iliescu DG. Ductus Venosus Agenesis and Portal System Anomalies-Association and Outcome. BIOLOGY 2022; 11:548. [PMID: 35453747 PMCID: PMC9031854 DOI: 10.3390/biology11040548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
To evaluate the prenatal diagnosis of agenesis of ductus venosus (ADV) and portal venous system (PVS) anomalies and describe the outcome of these cases, either isolated or associated. We evaluated the intrahepatic vascular system regarding the presence of normal umbilical drainage and PVS characteristics in the second and third trimester of pregnancy. The associated anomalies and umbilical venous drainage were noted. Follow-up was performed at six months follow-up. Ultrasonography was performed in 3517 cases. A total of 19 cases were prenatally diagnosed: 18 ADV cases, seven abnormal PVS cases, and six associations of the two anomalies. We noted an incidence of 5.1‱ and 1.9‱ for ADV and PVS anomalies, respectively. Out of the 18 ADV cases, 27.7% were isolated. Five cases (26.3%) presented genetic anomalies. PVS anomalies were found in 33.3% of the ADV cases. ADV was present in 85.7% of the PVS anomalies. DV and PVS abnormalities were found with a higher than reported frequency. Normal DV is involved in the normal development of the PVS. Additional fetal anomalies are the best predictor for the outcome of ADV cases. Evaluation of PVS represents a powerful predictor for ADV cases and addresses the long-term prognosis.
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Affiliation(s)
- Rodica Daniela Nagy
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.D.N.); (L.M.D.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Nicolae Cernea
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
| | - Anda Lorena Dijmarescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Maria-Magdalena Manolea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - George-Lucian Zorilă
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Roxana Cristina Drăgușin
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Sidonia Cătălina Vrabie
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Laurențiu Mihai Dîră
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.D.N.); (L.M.D.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Ovidiu Costinel Sîrbu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Marius Bogdan Novac
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (N.A.M.D.)
- Department of Anesthesia and Intensive Care, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Nicoleta Alice Marinela Drăgoescu
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (N.A.M.D.)
- Department of Anesthesia and Intensive Care, University Emergency County Hospital, 200642 Craiova, Romania
| | - Mihaela Gheonea
- Department of Neonatology, University Emergency County Hospital, 200642 Craiova, Romania;
- Department of Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - George Alin Stoica
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
- Department of Pediatric Orthopedic Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Pediatric Orthopedic Surgery, University Emergency County Hospital, 200642 Craiova, Romania
| | - Răzvan Grigoraș Căpitănescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Dominic-Gabriel Iliescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
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Tabbara F, Ataya KW, Annous Y, Alamiddine K, Zaghal A. Complicated acute appendicitis in a child with left atrial isomerism: a case report. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Heterotaxy syndrome is a rare clinical entity that is characterized by abnormal visceral organ arrangement in the chest and abdomen. Left atrial isomerism is a subcategory of heterotaxy syndrome characterized by the presence of multiple spleens with or without cardiac anomalies. Patients may remain asymptomatic their whole lives until they are diagnosed incidentally. Given that patients with left atrial isomerism might demonstrate atypical presentations of acute intrabdominal pathologies, it is important to keep a high index of suspicion when encountering such cases.
Case presentation
In this report, we present a case of a 9-year-old boy with a known history of left atrial isomersim who presented with left lower quadrant pain and positive McBurney, psoas, and obturator signs on the left side. A computed tomography scan of the abdomen confirmed the diagnosis of perforated acute appendicitis on the left, which prompted an emergent laparoscopic appendectomy.
Conclusion
Our case highlights the importance of keeping a high index of suspicion for a heterotaxy syndrome that is complicated by acute appendicitis in pediatric patients presenting with vague abdominal pain. Planning the location of trocar placement in patients with situs anomalies is of paramount importance to avoid technical difficulties in laparoscopic procedures.
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Tanaka H, Saijo Y, Tomonari T, Tanaka T, Taniguchi T, Yagi S, Okamoto K, Miyamoto H, Sogabe M, Sato Y, Muguruma N, Tsuneyama K, Sata M, Takayama T. An Adult Case of Congenital Extrahepatic Portosystemic Shunt Successfully Treated with Balloon-occluded Retrograde Transvenous Obliteration. Intern Med 2021; 60:1839-1845. [PMID: 33456037 PMCID: PMC8263181 DOI: 10.2169/internalmedicine.5914-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 42-year-old woman visited our hospital due to syncope. Contrast-enhanced CT revealed portosystemic shunt, portal vein hypoplasia, and multiple liver nodules. The histological examination of a liver biopsy specimen exhibited portal vein hypoplasia and revealed that the liver tumor was positive for glutamine synthetase. The patient was therefore diagnosed with congenital extrahepatic portosystemic shunt type II, and with focal nodular hyperplasia (FNH)-like nodules. She had the complication of severe portopulmonary hypertension and underwent complete shunt closure by balloon-occluded retrograde transvenous obliteration (B-RTO). The intrahepatic portal vein was well developed at 1 year after B-RTO, and multiple liver nodules completely regressed. Her pulmonary hypertension also improved.
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Affiliation(s)
- Hironori Tanaka
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Tetsu Tomonari
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Takahiro Tanaka
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Tatsuya Taniguchi
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Koichi Okamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Masahiro Sogabe
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Yasushi Sato
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Naoki Muguruma
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Koichi Tsuneyama
- Department of Pathology and Laboratory Medicine, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
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Namgoong JM, Hwang S, Kim DY, Ha TY, Song GW, Jung DH, Kim KM, Oh SH. Pediatric liver transplantation using a hepatitis B surface antigen-positive donor liver graft for congenital absence of the portal vein. KOREAN JOURNAL OF TRANSPLANTATION 2021; 35:59-65. [PMID: 35769617 PMCID: PMC9235344 DOI: 10.4285/kjt.20.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/13/2022] Open
Abstract
Congenital absence of the portal vein (CAPV) is a rare venous malformation in which mesenteric venous blood drains directly into systemic circulation. Herein, we report a case of pediatric deceased donor liver transplantation (DDLT) for symptomatic CAPV with whole liver graft from a hepatitis B surface antigen (HBsAg)-positive donor. A 4-year-old boy suffered from CAPV and secondary portal hypertension. He was also diagnosed with DiGeorge syndrome and heart anomalies. After waiting for 4 months, a 5-year-old donor weighing 19 kg with positive HBsAg was allocated to this 4-year-old patient weighing 15 kg. Recipient operation was performed according to the standard procedures of pediatric DDLT. Portal vein reconstruction was performed using interposition of a vascular homograft conduit to the superior mesenteric vein-splenic vein confluence. The patient recovered uneventfully from DDLT. He has been administered with lamivudine to prevent hepatitis B virus infection. This patient has been doing well for 5 years after DDLT without growth retardation. In conclusion, CAPV patients can have various vascular anomalies, thus combined vascular anomalies should be thoroughly assessed before and during liver transplantation operation. The most effective reconstruction techniques should be used to achieve satisfactory results following liver transplantation.
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Affiliation(s)
- Jung-Man Namgoong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Yeon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Mo Kim
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seak Hee Oh
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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He X, Zhu Y, Fu H, Feng C, Liu Z, Gu W, Jin Y, Yang B, Shen H. Case Report: Membranoproliferative Glomerulonephritis, a Rare Clinical Manifestation of Abernethy Malformation Type II. Front Pediatr 2021; 9:647364. [PMID: 33816407 PMCID: PMC8010253 DOI: 10.3389/fped.2021.647364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022] Open
Abstract
This report describes an 8-year-old male who presented with clinical manifestations including systemic edema, heavy proteinuria, hypoproteinemia, and persistent hypocomplementemia. Arachnoid cysts and focal nodular hyperplasia were also detected. Imaging examination and renal biopsy were performed, and Abernethy malformation type II with immune complex-mediated membranoproliferative glomerulonephritis was considered the diagnosis. Due to the persistence of embryonic vessels, Abernethy malformation is a rare congenital vascular malformation of the splanchnic venous system, which can be classified as type I (end-to-side shunt) and type II (side-to-side shunt). Abernethy malformation with glomerulonephritis remains extremely rare. In the patient described, glomerulonephritis mediated by immune complex with "full-house" positive immunohistochemistry was confirmed on renal biopsy. In addition, he was treated with glucocorticoids and tacrolimus. Whether surgical treatment is necessary should be determined according to the state of the disease in the later stages. The present case reflects the association between the congenital portosystemic shunt and the renal region and, to the authors' knowledge, may be the first report to describe arachnoid cysts as a symptom of Abernethy malformation.
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Affiliation(s)
- Xue He
- Department of Nephrology, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yueling Zhu
- Department of Traditional Chinese Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haidong Fu
- Department of Nephrology, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunyue Feng
- Department of Nephrology, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhixia Liu
- Department of Nephrology, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weizhong Gu
- Department of Pathology, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanyan Jin
- Department of Nephrology, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Binbin Yang
- Department of General Surgery, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huijun Shen
- Department of Nephrology, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Slowik V, Hildreth A, Pacheco MC, Finn LS, King J, Shivaram G, Files M, Hsu EK, Horslen S. Hepatopulmonary Syndrome in an Adolescent With Insidious Hypoxia and Small Intrahepatic Portal Venous Shunts: Posttransplant Benefit From Sildenafil. Pediatr Dev Pathol 2020; 23:467-471. [PMID: 32813578 DOI: 10.1177/1093526620945951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a patient without known preexisting liver disease who presented with hepatopulmonary syndrome (HPS) due to aberrant intrahepatic portal venous development leading to portosystemic shunting. Liver transplantation resulted in resolution of portal hypertension and HPS and sildenafil was safely tolerated in the treatment of persistent fatigue and hypoxemia. Twelve months later, patient has normal allograft function and has returned to normal activity.
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Affiliation(s)
- Voytek Slowik
- Division of Gastroenterology Hepatology and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
| | - Amber Hildreth
- Division of Gastroenterology Hepatology and Nutrition, Presbyterian/St. Luke's Transplant Center, Rocky Mountain Hospital for Children, Denver, Colorado
| | - M Cristina Pacheco
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington
| | - Laura S Finn
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington
| | - Jeremy King
- Department of Pediatrics, Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii
| | - Giridhar Shivaram
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Matthew Files
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington
| | - Evelyn K Hsu
- Division of Gastroenterology Hepatology and Nutrition, Seattle Children's Hospital, Seattle, Washington
| | - Simon Horslen
- Division of Gastroenterology Hepatology and Nutrition, Seattle Children's Hospital, Seattle, Washington
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11
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Matsumoto N, Matsusaki T, Hiroi K, Kaku R, Yoshida R, Umeda Y, Yagi T, Morimatsu H. Pediatric Living Donor Liver Transplantation for Congenital Absence of the Portal Vein With Pulmonary Hypertension: A Case Report. Transplant Proc 2020; 52:630-633. [PMID: 32029317 DOI: 10.1016/j.transproceed.2019.11.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/12/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022]
Abstract
Few reports of liver transplantation exist in patients with congenital absence of the portal vein and pulmonary hypertension. Living donor liver transplantation is usually performed before exacerbation of pulmonary hypertension. A 7-year-old girl (height: 131.5 cm; weight: 27.4 kg) with congenital absence of the portal vein was diagnosed with pulmonary hypertension (mean pulmonary artery pressure 35 mm Hg), and liver transplantation was planned before exacerbation of pulmonary hypertension. We successfully managed her hemodynamic parameters using low-dose dopamine and noradrenaline under monitoring of arterial blood pressure, central venous pressure, cardiac output, and stroke volume variation. Anesthesia was maintained using air-oxygen-sevoflurane and remifentanil 0.1 to 0.6 μg∙kg-1∙min-1. It is necessary to understand the potential perioperative complications in such cases and to adopt a multidisciplinary team approach in terms of the timing of transplantation and readiness to deal with exacerbation of pulmonary hypertension.
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Affiliation(s)
- Naohisa Matsumoto
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Takashi Matsusaki
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan.
| | - Kazumasa Hiroi
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Ryuji Kaku
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuzo Umeda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takahito Yagi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
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12
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Guo C, Zhong YM, Wang Q, Hu LW, Gu XH, Shao H, Wu W, Cao JF, Qiu HS. Diagnostic accuracy of multi-slice computed tomography in children with Abernethy malformation. BMC Med Imaging 2019; 19:97. [PMID: 31847826 PMCID: PMC6918646 DOI: 10.1186/s12880-019-0396-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/28/2019] [Indexed: 12/23/2022] Open
Abstract
Background Abernethy malformation is a rare congenital abnormality. Imaging examination is an important method for the diagnosis. The purpose of this study was to demonstrate manifestations of multi-slice computed tomography (MSCT) in Abernethy malformation and its diagnostic accuracy. Methods Fourteen children with Abernethy malformation were admitted to our center in China between July 2011 and January 2018. All 14 patients (eight males and six females) received MSCT and digital subtraction angiography (DSA) while eight patients also received ultrasound. The patients’ age ranged from 1 to 14 (median age 8 years old). The clinical records of the patients were retrospectively reviewed. MSCT raw data were transferred to an Advantage Windows 4.2 or 4.6 workstation (General Electric Medical Systems, Waukesha, WI). We compared the findings of MSCT with DSA and surgical results in order to ascertain diagnostic accuracy. Results Three cases had type Ib Abernethy malformation and eleven cases had type II. Two cases of type II Abernethy malformation were misdiagnosed as type Ib using MSCT. Comparing the findings of MSCT with DSA and surgical results, the accuracy of MSCT was 85.7% (12/14), in which 100.0% (3/3) were type Ib and 81.8% (9/11) were type II. Clinical information included congenital heart disease, pulmonary hypertension, diffuse pulmonary arteriovenous fistula, abnormal liver function, hepatic nodules, elevated blood ammonia, and hepatic encephalopathy. Eleven cases were treated after diagnosis. One patient with Abernethy malformation type Ib (1/3) underwent liver transplantation. Seven patients with Abernethy malformation type II (7/11) were treated by shunt occlusion, received laparoscopy, or were treated with open surgical ligation. Another three patients (3/11) with Abernethy malformation type II were treated by interventional portocaval shunt occlusion under DSA. Conclusion MSCT attains excellent capability in diagnosing type II Abernethy malformation and further shows the location of the portocaval shunt. DSA can help when it is hard to determine diagnosis between Abernethy type Ib and II using MSCT.
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Affiliation(s)
- Chen Guo
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
| | - Yu-Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China.
| | - Qian Wang
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
| | - Li-Wei Hu
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
| | - Xiao-Hong Gu
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
| | - Hong Shao
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
| | - Wei Wu
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
| | - Jian-Feng Cao
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
| | - Hai-Sheng Qiu
- Diagnostic Imaging Center, Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Road, Shanghai, 200127, People's Republic of China
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Kemp SR. Sonography Aids in Diagnosis of Congenital Absence of Portal Vein in Patient With Marfan Syndrome: A Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319848747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Skylar R. Kemp
- Department of Radiology Ultrasound, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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14
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Yangın-Ergon E, Ermis N, Colak R, Polat B, Alkan-Ozdemir S, Yıldız M, Kulalı F, Omur-Ecevit C, Ergun O, Calkavur S. Abernethy Malformation Type 2 and Biliary Atresia Coexistence: A Rare Cause of Infantile Liver Transplant. Euroasian J Hepatogastroenterol 2019; 8:163-166. [PMID: 30828559 PMCID: PMC6395480 DOI: 10.5005/jp-journals-10018-1283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/20/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction Abernethy malformation is a very rare condition in which mesenteric venous blood is drained into systemic circulation by an extra hepatic portosystemic shunt. Here we present a case of a female in infantile period who is a liver transplant candidate with biliary atresia and ventricular septal defect (VSD) accompanying Abernethy malformation type 2. Case report The patient who underwent Kasai operation at postnatal day 35 was identified as a liver transplant candidate in the postnatal month 6 due to growth retardation in the infantile period, insufficient weight gain and liver failure (portal hypertension and massive gastrointestinal bleeding). Conclusion Abernethy malformation is divided into two groups as type 1 and type 2; type 2 shunts, which are less common, but more common in males, are not accompanied by other congenital anomalies. Due to the female gender, having biliary atresia and VSD, the development of liver failure at an early stage despite undergoing Kasai operation at the appropriate time, our case differs from the literature. In conclusion, this case is presented in order to indicate the proper and effective use of imaging methods in neonatal cholestasis cases.How to cite this article: Ergon EY, Ermis N, Colak R, Polat B, Ozdemir S, Yildiz M, Kulali F, Ecevit C, Ergun O, Calkavur S. Abernethy Malformation Type 2 and Biliary Atresia Coexistence: A Rare Cause of Infantile Liver Transplant. Euroasian J Hepatogastroenterol, 2018;8(2):163-166.
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Affiliation(s)
- Ezgi Yangın-Ergon
- Department of Neonatology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Nebahat Ermis
- Department of Neonatology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Ruya Colak
- Department of Neonatology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Burak Polat
- Department of Pediatric Radiology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Senem Alkan-Ozdemir
- Department of Neonatology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Meral Yıldız
- Department of Neonatology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Ferit Kulalı
- Department of Neonatology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Cigden Omur-Ecevit
- Department of Pediatric Gastroenterology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery and Transplantation, Ege University Hospital, Izmir, Turkey
| | - Sebnem Calkavur
- Department of Neonatology, Dr. BehCet Uz Pediatric Diseases and Surgery Education Research Hospital, Izmir, Turkey
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15
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Kim ES, Lee KW, Choe YH. The Characteristics and Outcomes of Abernethy Syndrome in Korean Children: A Single Center Study. Pediatr Gastroenterol Hepatol Nutr 2019; 22:80-85. [PMID: 30671377 PMCID: PMC6333588 DOI: 10.5223/pghn.2019.22.1.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/12/2018] [Accepted: 06/22/2018] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Abernethy malformation is a rare condition, which was first described in 1793 as a congenital extrahepatic porto-systemic shunt (CEPS) directing splanchnic blood flow into the inferior vena cava. Eighty cases have been published so far that reported CEPS, while in Korea, very few cases have been reported. Through this study, we present 6 cases of patients diagnosed with CEPS at Samsung Medical Center and compare these with other such cases published in France and China. METHODS We reviewed clinical, laboratory, and imaging data of 6 children with CEPS in our pediatric clinic between 2004 and 2017. RESULTS A total of 6 children with CEPS was included in this study, namely, one with type 1a, two with type 1b, and three with type 2 CEPS. The most common presenting symptom was gastrointestinal bleeding (50.0%). Therapeutic interventions included shunting vessel ligation (16.7%) in type 2 CEPS and liver transplantation (16.7%) in type 2 CEPS patient with suddenly developed hepatic encephalopathy. CONCLUSION There is no consensus guideline for the optimal management of patients with CEPS. Large-sample studies regarding CEPS are needed to evaluate the characteristics of patients with CEPS and determine the treatment guideline for CEPS.
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Affiliation(s)
- Eun Sil Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Wuk Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University School of Medicine, Seongnam, Korea
| | - Yon Ho Choe
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Zhang JS, Li L, Cheng W, Hou WY. Rex Shunt as a Treatment of Type II Abernethy Malformation with Severe Dysplasia of Portal Vein. Ann Vasc Surg 2018; 53:268.e1-268.e6. [DOI: 10.1016/j.avsg.2018.05.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/11/2018] [Accepted: 05/04/2018] [Indexed: 12/16/2022]
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17
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Ponziani FR, Faccia M, Zocco MA, Giannelli V, Pellicelli A, Ettorre GM, De Matthaeis N, Pizzolante F, De Gaetano AM, Riccardi L, Pompili M, Rapaccini GL. Congenital extrahepatic portosystemic shunt: description of four cases and review of the literature. J Ultrasound 2018; 22:349-358. [PMID: 30357760 DOI: 10.1007/s40477-018-0329-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/24/2018] [Indexed: 12/12/2022] Open
Abstract
Congenital extrahepatic portosystemic shunt (CEPS), also known as Abernethy malformation, is a rare condition in which the splenomesenteric blood drains directly into a systemic vein, bypassing the liver through a complete or partial shunt. The diagnosis is frequently made during childhood in the setting of neonatal cholestasis, hypergalactosemia, failure to thrive, mental retardation or other congenital defects. In adulthood, CEPS is usually found incidentally during diagnostic work-up for abdominal pain, liver test abnormalities, liver nodules, portopulmonary hypertension, portopulmonary syndrome or portosystemic encephalopathy. The diagnosis depends on imaging and portal venography, but sometimes only liver biopsy can be resolutive, demonstrating the absence of venules within the portal areas. Here we report four recent cases of Abernethy malformation diagnosed in young adults, in which ultrasound (US) was the initial imaging technique and allowed to suspect the diagnosis. Furthermore, we reviewed clinical presentations, associated anomalies and treatment of the 310 cases of CEPS previously reported in the literature.
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Affiliation(s)
- Francesca Romana Ponziani
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Mariella Faccia
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Maria Assunta Zocco
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | | | - Giuseppe Maria Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
| | - Nicoletta De Matthaeis
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Fabrizio Pizzolante
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | - Laura Riccardi
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Maurizio Pompili
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Gian Ludovico Rapaccini
- Internal Medicine, Gastroenterology and Hepatology, Fondazione IRCCS Agostino Gemelli Hospital, Largo Agostino Gemelli 8, 00168, Rome, Italy
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18
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Sanada Y, Mizuta K. Congenital absence of the portal vein: translated version. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:359-369. [PMID: 30160060 DOI: 10.1002/jhbp.572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Congenital portosystemic shunt (CPS) is classified into type I (congenital absence of the portal vein) and type II, depending on the presence or absence of the intrahepatic portal vein. Reports still exist on cases in which psychiatric diseases or mental retardation was diagnosed or cases in which diagnosis and treatment are not performed until severe pulmonary complications occur, indicating the need to recognize CPS. Herein, we reviewed epidemiology, etiology, classification, symptom, diagnosis, and treatment based on clinical view points of CPS. For clinical view points, classification according to (1) the presence or absence of the intrahepatic portal venous system (IPVS) and (2) the extrahepatic or intrahepatic of shunt sites, facilitates the understanding of pathophysiological conditions and is useful in selecting a treatment for symptomatic CPS. Radiological and pathological examinations are important in IPVS evaluations, and IPVS evaluations are currently essential to make diagnoses by portography with balloon occlusion and liver biopsy. Symptomatic CPS (hepatic nodular lesions, portosystemic encephalopathy, and pulmonary complications, etc.) is an indication of treatment by shunt closure, but an indication of treatment for asymptomatic CPS is the challenge going forward.
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Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan
| | - Koichi Mizuta
- Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi 329-0498, Japan
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19
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Holloway A, Groot L, van der Schaaf K. Congenital absence of the portal vein in a cat. JFMS Open Rep 2018; 4:2055116917749079. [PMID: 29372068 PMCID: PMC5774732 DOI: 10.1177/2055116917749079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
CASE SUMMARY A 9-month-old female neutered domestic shorthair cat presented with a history of episodic ptyalism, lethargy and abnormal behaviour. The clinical signs together with elevated pre- and post-prandial bile acid concentrations were consistent with hepatic encephalopathy (HE). In the absence of a portosystemic shunt (PSS) on abdominal ultrasound, medical management of HE was established with a protein-restricted diet and lactulose and the neurological signs resolved. Following an episode of acute vomiting and haemorrhagic diarrhoea at 19 months of age abdominal ultrasonography was repeated. The portal vein could not be demonstrated ultrasonographically; instead, portal vein tributaries were tortuous and communicated with the caudal vena cava (CdVC) at the level of the left kidney. CT angiography (CTA) confirmed the absence of the portal vein. CTA demonstrated the tortuous terminations of the portal tributaries, and several systemic veins, draining into the CdVC via a large-diameter paracaval vessel at the level of the left kidney. Gastrointestinal signs were stabilised and medical management for HE of a protein-restricted diet and lactulose was re-established. RELEVANCE AND NOVEL INFORMATION Congenital absence of the portal vein has not been described previously in the cat and should be considered in cats presenting with signs suggestive of a PSS and HE. The portal vein in the cat can be demonstrated using ultrasound, but complex congenital vascular malformations of the portal or systemic abdominal veins should be characterised using CTA and further distinguished from other vascular anomalies that may present with similar ultrasonographic features.
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Affiliation(s)
| | - Louise Groot
- Goddard Veterinary Hospital, Wanstead, London, UK
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20
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Zhang XL, Duan XM, Wang FY, Zhang X, Sun Y, Ma N, Du ZD. An Infant with Abernethy Malformation Associated with Heterotaxy and Pulmonary Hypertension. Chin Med J (Engl) 2017; 130:2257-2258. [PMID: 28875963 PMCID: PMC5598340 DOI: 10.4103/0366-6999.213978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Xiao-Lin Zhang
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiao-Min Duan
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Fang-Yun Wang
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xin Zhang
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yan Sun
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Ning Ma
- Department of Echocardiography, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Zhong-Dong Du
- Department of Pediatrics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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21
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Mi XX, Li XG, Wang ZR, Lin L, Xu CH, Shi JP. Abernethy malformation associated with Caroli's syndrome in a patient with a PKHD1 mutation: a case report. Diagn Pathol 2017; 12:61. [PMID: 28814334 PMCID: PMC5559867 DOI: 10.1186/s13000-017-0647-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/20/2017] [Indexed: 12/19/2022] Open
Abstract
Background Abernethy malformation is a rare congenital anomaly characterised by the partial or complete absence of the portal vein and the subsequent development of an extrahepatic portosystemic shunt. Caroli’s disease is a rare congenital condition characterised by non-obstructive saccular intrahepatic bile duct dilation. Caroli’s disease combined with congenital hepatic fibrosis and/or renal cystic disease is referred to - Caroli’s syndrome. The combination of Abernethy malformation and Caroli’s syndrome has not been reported previously. Case presentation We present the case of a 23-year-old female who was found to have both type II Abernethy malformation and Caroli’s syndrome. Radiological imaging was performed, including computed tomography with three-dimensional reconstruction and magnetic resonance imaging with (magnetic resonance cholangiopancreatography (MRCP), which revealed a side-to-side portocaval shunt, intrahepatic bile duct dilation, congenital hepatic fibrosis, and renal cysts. In addition, PKHD1 (polycystic kidney and hepatic disease 1) gene mutational analysis revealed a paternally inherited heterozygous missense mutation (c.1877A > G, p.Lys626Arg). A liver biopsy confirmed the pathological features of Caroli’s syndrome. Conclusions To our knowledge, this is the first reported case of a patient with both type II Abernethy malformation and Caroli’s syndrome diagnosed using a comprehensive approach that included imaging, mutational analysis, and liver biopsy. Additionally, this is the second reported case to date of an Asian patient presenting with liver and renal disorders with the same paternally inherited PKHD1 missense mutation.
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Affiliation(s)
- Xiao-Xiao Mi
- Institute of Translational Medicine, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Xiao-Guang Li
- Department of Infectious Diseases, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zi-Rong Wang
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Ling Lin
- Shanghai Biotecan Medical Diagnostics Corporation, Shanghai, China
| | - Chun-Hai Xu
- Department of Infectious Diseases, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Jun-Ping Shi
- Institute of Translational Medicine, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China.
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22
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Benedict M, Rodriguez-Davalos M, Emre S, Walther Z, Morotti R. Congenital Extrahepatic Portosystemic Shunt (Abernethy Malformation Type Ib) With Associated Hepatocellular Carcinoma: Case Report and Literature Review. Pediatr Dev Pathol 2017; 20:354-362. [PMID: 28727971 DOI: 10.1177/1093526616686458] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abernethy malformation, also termed congenital portosystemic shunt and congenital absence of portal vein is the result of malformation of the splanchnic venous system. Congenital portosystemic shunts are divided into extra- and intrahepatic shunts. Two shunts have been defined: Type I is characterized by the complete diversion of portal blood into the vena cava with an associated congenital absence of the portal vein. Type II is defined by an intact but diverted portal vein through a side-to-side, extrahepatic connection to the vena cava. The clinical manifestations of Abernethy malformation are diverse with a typical presentation consisting of hypoxia and hepto-pulmonary syndrome. Histologically, focal nodular hyperplasia, nodular regenerative hyperplasia, liver adenoma, hepatoblastoma, and hepatocellular carcinoma have all been reported. Herein, we report a case of Abernethy malformation, type Ib, in a 12-month-old male who was found to have a small hepatocellular carcinoma at the time of explant. The immunohistochemical characteristics in relation to the genetic aspects are discussed. To our knowledge, this is the first reported case of hepatocellular carcinoma developing in a patient who is under the age of 5 years with Abernethy malformation.
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Affiliation(s)
- Mark Benedict
- 1 Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Sukru Emre
- 2 Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zenta Walther
- 1 Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Raffaella Morotti
- 1 Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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Happaerts S, Foucault A, Billiard JS, Nguyen B, Vandenbroucke-Menu F. Combined hepatocellular-cholangiocarcinoma in a patient with Abernethy malformation and tetralogy of Fallot: A case report. Hepatology 2016; 64:1800-1802. [PMID: 27227347 DOI: 10.1002/hep.28656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/06/2015] [Accepted: 05/19/2016] [Indexed: 12/11/2022]
Abstract
Abernethy malformation is a rare congenital anomaly of the portal vein where the portal blood bypasses the liver. We report the first case of a patient with Abernethy malformation and tetralogy of Fallot associated with nodular regenerative hyperplasia and focal nodular hyperplasia (FNH), which finally evolved to a giant hepatocellular-cholangiocarcinoma (HCC-CC) of the liver, successfully resected. (Hepatology 2016;64:1800-1802).
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Affiliation(s)
- Sofie Happaerts
- Service de chirurgie hépatobiliaire, pancréatique et de transplantation hépatique, Centre Hospitalier de l'Université de Montréal, Montreal, Qc, Canada
| | - Amélie Foucault
- Service de chirurgie hépatobiliaire, pancréatique et de transplantation hépatique, Centre Hospitalier de l'Université de Montréal, Montreal, Qc, Canada
| | | | - Bich Nguyen
- Service de pathologie, Centre Hospitalier de l'Université de Montréal, Montreal, Qc, Canada
| | - Franck Vandenbroucke-Menu
- Service de chirurgie hépatobiliaire, pancréatique et de transplantation hépatique, Centre Hospitalier de l'Université de Montréal, Montreal, Qc, Canada.
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24
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Liver transplantation in an adult with adenomatosis and congenital absence of the portal vein: a case report. Transplant Proc 2015; 46:2418-21. [PMID: 25242797 DOI: 10.1016/j.transproceed.2014.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/01/2014] [Indexed: 02/07/2023]
Abstract
Congenital absence of the portal vein (CAPV) is a rare congenital anomaly in which the superior mesenteric veins (SMV) and splenic veins converge and bypass the liver, effectively draining directly into the systemic venous circulation via the inferior vena cava (IVC), or alternatively the renal or iliac vein, creating a native portosystemic shunt. Portosystemic shunting results in clinical manifestations of hepatic encephalopathy as well as a predisposition to focal nodular hyperplasia and tumors, including adenomas, hepatoblastoma, and hepatocellular carcinoma (HCC), by the disruption of enterohepatic blood flow. Historically, CAPV has been thought to be a rare condition found mainly at autopsy, however, in recent years due to advances in radiological techniques, CAPV detection has increased. Herein we describe a patient with known CAPV who initially underwent hepatic resection for HCC. During surveillance, additional masses were discovered and were identified as recurrent HCC. Unfortunately, this patient was not a candidate for further resection or locoregional therapy. We demonstrate that transplantation is a challenging but technically viable option for treatment of HCC complicating adenomatosis-associated CAPV.
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Brasoveanu V, Ionescu MI, Grigorie R, Mihaila M, Bacalbasa N, Dumitru R, Herlea V, Iorgescu A, Tomescu D, Popescu I. Living Donor Liver Transplantation for Unresectable Liver Adenomatosis Associated with Congenital Absence of Portal Vein: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:637-44. [PMID: 26386552 PMCID: PMC4581685 DOI: 10.12659/ajcr.895235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abernethy malformation (AM), or congenital absence of portal vein (CAPV), is a very rare disease which tends to be associated with the development of benign or malignant tumors, usually in children or young adults. CASE REPORT We report the case of a 21-year-old woman diagnosed with type Ib AM (portal vein draining directly into the inferior vena cava) and unresectable liver adenomatosis. The patient presented mild liver dysfunction and was largely asymptomatic. Living donor liver transplantation was performed using a left hemiliver graft from her mother. Postoperatively, the patient attained optimal liver function and at 9-month follow-up has returned to normal life. CONCLUSIONS We consider that living donor liver transplantation is the best therapeutic solution for AM associated with unresectable liver adenomatosis, especially because compared to receiving a whole liver graft, the waiting time on the liver transplantation list is much shorter.
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Affiliation(s)
- Vladislav Brasoveanu
- "Dan Setlacec" Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihnea Ioan Ionescu
- "Dan Setlacec" Center for General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Razvan Grigorie
- "Dan Setlacec" Center of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Mariana Mihaila
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Dumitru
- Department of Radiology and Imagistics, Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Herlea
- Department of Morphopathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andreea Iorgescu
- Department of Morphopathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Dana Tomescu
- Department of Anesthesiology, Fundeni Clinical Institute, Bucharest, Romania
| | - Irinel Popescu
- "Dan Setlacec" Center for General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
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Sanada Y, Mizuta K, Niki T, Tashiro M, Hirata Y, Okada N, Yamada N, Ihara Y, Urahashi T, Soejima Y, Fukusato T, Kondo F. Hepatocellular nodules resulting from congenital extrahepatic portosystemic shunts can differentiate into potentially malignant hepatocellular adenomas. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:746-56. [DOI: 10.1002/jhbp.277] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/18/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Yukihiro Sanada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Koichi Mizuta
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Toshiro Niki
- Department of Pathology; Jichi Medical University; Shimotsuke City Japan
| | - Masahisa Tashiro
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Yuta Hirata
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Noriki Okada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Naoya Yamada
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Yoshiyuki Ihara
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Taizen Urahashi
- Department of Transplant Surgery; Jichi Medical University; Shimotsuke City Japan
| | - Yurie Soejima
- Department of Pathology; Teikyo University School of Medicine; Itabashi City Japan
| | - Toshio Fukusato
- Department of Pathology; Teikyo University School of Medicine; Itabashi City Japan
| | - Fukuo Kondo
- Department of Pathology; Teikyo University School of Medicine; Itabashi City Japan
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27
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Congenital Absence of Portal Vein With Cecal Varices. J Clin Gastroenterol 2015; 49:629. [PMID: 25984979 DOI: 10.1097/mcg.0000000000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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28
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Morse B, Strosberg J. Congenital Anomaly Detected During Work-up of Cystic Pancreatic Lesion. Gastroenterology 2015; 149:33-4. [PMID: 26025308 DOI: 10.1053/j.gastro.2015.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 01/30/2015] [Accepted: 02/10/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Brian Morse
- Department of Diagnostic Imaging, Moffitt Cancer Center, Tampa, Florida
| | - Jonathan Strosberg
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
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Kwapisz L, Wells MM, AlJudaibi B. Abernethy malformation: congenital absence of the portal vein. Can J Gastroenterol Hepatol 2014; 28:587-8. [PMID: 25575105 PMCID: PMC4277169 DOI: 10.1155/2014/675812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lukasz Kwapisz
- Department of Internal Medicine, Western University, London, Ontario
| | - Malcolm M Wells
- Department of Gastroenterology and Hepatology, Western University, London, Ontario
| | - Bandar AlJudaibi
- Department of Gastroenterology and Hepatology, Western University, London, Ontario
- Department of Gastroenterology, King Khalid University Hospital, King Saud University, Saudi Arabia
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30
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Spruijt OA, Bogaard HJ, Vonk-Noordegraaf A. Pulmonary arterial hypertension combined with a high cardiac output state: Three remarkable cases. Pulm Circ 2013; 3:440-3. [PMID: 24015348 PMCID: PMC3757842 DOI: 10.4103/2045-8932.113185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A congenital extrahepatic portosystemic venous shunt (CEPVS), also known as an Abernethy malformation, is a rare cause of pulmonary arterial hypertension (PAH). In this case series, we describe three male patients of 30, 23, and 27 years of age with PAH due to a CEPVS. In all three patients, a right heart catheterization revealed a high cardiac output. The aim of this case series is to make pulmonary hypertension physicians aware of the possibility of a CEPVS when PAH is accompanied with a high cardiac output state.
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Affiliation(s)
- Onno A Spruijt
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
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31
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Velayutham P, Dev A, Arora A. Congenital extrahepatic portocaval shunt: growth in vain. J Pediatr 2013; 162:1076.e1. [PMID: 23295141 DOI: 10.1016/j.jpeds.2012.11.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 11/13/2012] [Indexed: 12/13/2022]
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32
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Schaeffer DF, Laiq S, Jang HJ, John R, Adeyi OA. Abernethy malformation type II with nephrotic syndrome and other multisystemic presentation: an illustrative case for understanding pathogenesis of extrahepatic complication of congenital portosystemic shunt. Hum Pathol 2013; 44:432-7. [DOI: 10.1016/j.humpath.2012.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 08/21/2012] [Accepted: 08/22/2012] [Indexed: 10/27/2022]
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33
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Ogul H, Bayraktutan U, Yalcin A, Turan MI, Ozgokce M, Eren S, Kantarci M. Congenital absence of the portal vein in a patient with multiple vascular anomalies. Surg Radiol Anat 2012; 35:529-34. [DOI: 10.1007/s00276-012-1059-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/11/2012] [Indexed: 02/01/2023]
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34
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Asrani SK, Asrani NS, Freese DK, Phillips SD, Warnes CA, Heimbach J, Kamath PS. Congenital heart disease and the liver. Hepatology 2012; 56:1160-9. [PMID: 22383293 DOI: 10.1002/hep.25692] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/19/2012] [Indexed: 01/05/2023]
Abstract
There are approximately 1 million adult patients with congenital heart disease (CHD) in the United States, and the number is increasing. Hepatic complications are common and may occur secondary to persistent chronic passive venous congestion or decreased cardiac output resulting from the underlying cardiac disease or as a result of palliative cardiac surgery; transfusion or drug-related hepatitis may also occur. The unique physiology of Fontan circulation is particularly prone to the development of hepatic complications and is, in part, related to the duration of the Fontan procedure. Liver biochemical test abnormalities may be related to cardiac failure, resulting from intrinsic liver disease, secondary to palliative interventions, or drug related. Complications of portal hypertension and, rarely, hepatocellular carcinoma (HCC) may also occur. Abnormalities such as hypervascular nodules are often observed; in the presence of cirrhosis, surveillance for HCC is necessary. Judicious perioperative support is required when cardiac surgery is performed in patients with advanced hepatic disease. Traditional models for liver disease staging may not fully capture the severity of disease in patients with CHD. The effectiveness or safety of isolated liver transplantation in patients with significant CHD is limited in adults; combined heart-liver transplantation may be required in those with decompensated liver disease or HCC, but experience is limited in the presence of significant CHD. The long-term sequelae of many reparative cardiac surgical procedures are not yet fully realized; understanding the unique and diverse hepatic associations and the role for early cardiac transplantation in this population is critical. Because this population continues to grow and age, consideration should be given to developing consensus guidelines for a multidisciplinary approach to optimize management of this vulnerable population.
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Affiliation(s)
- Sumeet K Asrani
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Witjes CDM, Ijzermans JNM, Noordegraaf AV, Tran TCK. Management strategy after diagnosis of Abernethy malformation: a case report. J Med Case Rep 2012; 6:167. [PMID: 22742057 PMCID: PMC3419678 DOI: 10.1186/1752-1947-6-167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 06/28/2012] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The Abernethy malformation is a rare anomaly with a widely variable clinical presentation. Many diagnostic dilemmas have been reported. Nowadays, with the evolution of medical imaging, diagnosis can be made more easily, but management of patients with an Abernethy malformation is still open for discussion. CASE PRESENTATION In this case study, we describe a 34-year-old Caucasian man who presented with a large hepatocellular carcinoma in the presence of an Abernethy malformation, which was complicated by the development of pulmonary arterial hypertension. CONCLUSION This case underlines the importance of regular examination of patients with an Abernethy malformation, even in older patients, to prevent complications and to detect liver lesions at an early stage.
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Affiliation(s)
- Caroline DM Witjes
- Department of Hepatobiliary and Transplantation Surgery, Erasmus Medical Center, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, The Netherlands
| | - Jan NM Ijzermans
- Department of Hepatobiliary and Transplantation Surgery, Erasmus Medical Center, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, VU University Medical Center Amsterdam, P.O. Box 7057, Amsterdam, MB, 1007, The Netherlands
| | - TC Khe Tran
- Department of Hepatobiliary and Transplantation Surgery, Erasmus Medical Center, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, The Netherlands
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36
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Scheuermann U, Foltys D, Otto G. Focal nodular hyperplasia proceeds hepatocellular carcinoma in an adult with congenital absence of the portal vein. Transpl Int 2012; 25:e67-8. [DOI: 10.1111/j.1432-2277.2012.01454.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Chandler TM, Heran MK, Chang SD, Parvez A, Harris AC. Multiple focal nodular hyperplasia lesions of the liver associated with congenital absence of the portal vein. Magn Reson Imaging 2011; 29:881-6. [DOI: 10.1016/j.mri.2011.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/07/2011] [Indexed: 12/12/2022]
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