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Yan J, Yin J, Zhang D, Lv C, Pang W, Chen Y. An unusual interventional approach to treat Type 2 Abernethy malformation in children: two case reports. Gastroenterol Rep (Oxf) 2024; 12:goad075. [PMID: 38187097 PMCID: PMC10769814 DOI: 10.1093/gastro/goad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Jiayu Yan
- Department of General Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, P. R. China
| | - Jie Yin
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, P. R. China
| | - Dan Zhang
- Department of General Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, P. R. China
| | - Chuankai Lv
- Department of Ultrasound, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, P. R. China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, P. R. China
| | - Yajun Chen
- Department of General Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, P. R. China
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2
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Gadiyaram S, Nachiappan M. An Unusual Cause of Lower Gastrointestinal Bleeding. Gastroenterology 2023; 164:e4-e7. [PMID: 36272458 DOI: 10.1053/j.gastro.2022.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Srikanth Gadiyaram
- Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospital, Bangalore, India.
| | - Murugappan Nachiappan
- Department of Surgical Gastroenterology and Minimally Invasive Surgery, Sahasra Hospital, Bangalore, India
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3
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Harlander M, Badovinac M, Markoska F, Salobir B, Štupnik T, Dolenšek MI, Kern I, Gorjup V, Galiè N. Case report: Congenital extrahepatic portocaval shunt presenting as pulmonary arterial hypertension in a pregnant patient. Pulm Circ 2022; 12:e12008. [PMID: 35506097 PMCID: PMC9052963 DOI: 10.1002/pul2.12008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Congenital extrahepatic portocaval shunt (CEPS) is a rare condition in which a rare congenital vascular anomaly of the portal system is present. CEPS may manifest as pulmonary arterial hypertension (PAH). When diagnosed and treated early, PAH can be reversible. We report a case of a previously asymptomatic woman, who manifested with severe pulmonary hypertension during pregnancy and was consequently diagnosed with CEPS. After unsuccessful medical treatment, urgent lung transplantation was done.
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Affiliation(s)
- Matevž Harlander
- Department of Pulmonary Diseases and Allergy University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Medicine Ljubljana University of Ljubljana Ljubljana Slovenia
| | - Maja Badovinac
- Department of Pulmonary Diseases and Allergy University Medical Centre Ljubljana Ljubljana Slovenia
| | - Frosina Markoska
- Department of Pulmonary Diseases and Allergy University Medical Centre Ljubljana Ljubljana Slovenia
| | - Barbara Salobir
- Department of Pulmonary Diseases and Allergy University Medical Centre Ljubljana Ljubljana Slovenia
- Faculty of Medicine Ljubljana University of Ljubljana Ljubljana Slovenia
| | - Tomaž Štupnik
- Faculty of Medicine Ljubljana University of Ljubljana Ljubljana Slovenia
- Department of Thoracic Surgery University Medical Centre Ljubljana Ljubljana Slovenia
| | - Marija Iča Dolenšek
- Institute of Radiology University Medical Centre Ljubljana Ljubljana Slovenia
| | - Izidor Kern
- Cytology and Pathology Laboratory University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia
| | - Vojka Gorjup
- Department of Intensive Internal Medicine University Medical Centre Ljubljana Ljubljana Slovenia
| | - Nazzareno Galiè
- DIMES S. Orsola University Hospital University of Bologna and IRCCS Bologna Italy
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4
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Bhat MA, Plunk MR, Basel DG, Hanson SJ. Cyanosis in a Previously Well Child. Pediatr Rev 2021; 42:619-624. [PMID: 34725222 DOI: 10.1542/pir.2020-002055] [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: 11/24/2022]
Affiliation(s)
| | - Matthew R Plunk
- Division of Pediatric Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
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5
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Dhakre VW, Shah P, Nagral SS, Nagral A. Letter to the Editor: Congenital Extrahepatic Portosystemic Shunts (Abernethy Malformation): A New Variant. Hepatology 2021; 74:2902. [PMID: 32563203 DOI: 10.1002/hep.31427] [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: 12/08/2022]
Affiliation(s)
- Vijay Waman Dhakre
- Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion Mumbai, India
| | - Preet Shah
- ST3 Trainee, Department of Endocrinology and Diabetes, Pinderfields General Hospital, Wakefield, United Kingdom
| | - Sanjay S Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital & Research Centre, Mumbai, India.,Department of Surgery, KB Bhabha General Hospital, Bandra (West) Mumbai, India
| | - Aabha Nagral
- Department of Medical Gastroenterology, Jaslok Hospital & Research Centre, Mumbai, India.,Apollo Hospital, Navi Mumbai, India
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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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Bobhate P, Garg S, Sharma A, Roy D, Raut A, Pawar R, Karande T, Kulkarni S. Congenital extrahepatic portocaval malformation: Rare but potentially treatable cause of pulmonary hypertension. Indian Heart J 2020; 73:99-103. [PMID: 33714417 PMCID: PMC7961257 DOI: 10.1016/j.ihj.2020.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/24/2020] [Accepted: 12/23/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Abernethy malformation (congenital extrahepatic portosystemic shunt) is a rare anomaly of the splanchnic venous system. Though rare, it is an important cause of pulmonary artery hypertension (PAH) which is often missed. All patients with PAH should be carefully evaluated for presence of Abernethy malformation before labelling them as Idiopathic PAH. METHODS This is a retrospective analysis of prospectively collected data. We reviewed the data of all patients referred to our center for evaluation of PAH. 10 patients were diagnosed to have an extrahepatic portocaval malformation. We reviewed their presentation, diagnosis, catheterization data, intervention and their outcome along with review of literature. RESULTS 10/104 patients with pulmonary hypertension and no intra or extracardiac shunt were found to have extrahepatic portocaval shunt (EHPCS). 3 patients had EHPCS type 1 and 7 had type 2 EHPCS. 6/7 patient with EHPCS type 2 underwent closure of the shunt. There was no procedure related complication. There was one death 3 months post procedure and one patient who was advised surgical closure was lost to follow up. Closure of the shunt resulted in normalization of the pulmonary artery pressures in 4/5 patients. CONCLUSION Congenital portosystemic malformations form an important and potentially treatable cause of pulmonary hypertension.
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Affiliation(s)
- Prashant Bobhate
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India.
| | - Sandeep Garg
- Department of Pediatrics, Bhaktivednata Hospital and Research Institute, Bhaktivendanta Swami Marg, Srishti Sector 1, Mira Road, Thane, 401107, India
| | - Anuj Sharma
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Diptiman Roy
- Department of Radiodiagnosis and Interventional Radiology, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Abhijeet Raut
- Department of Radiodiagnosis and Interventional Radiology, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Ravindra Pawar
- Consultant Pediatric Cardiologist, 15, Sawali Bunglow, Shivaji Park, Kolhapur, 416005, India
| | - Tanuja Karande
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
| | - Snehal Kulkarni
- Children's' Heart Center, Second Floor, Kokilaben Dhirubai Ambani Hospital and Research Center, Rao Achyut Rao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra, 400053, India
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8
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Thenappan T, Khoruts A, Chen Y, Weir EK. Can intestinal microbiota and circulating microbial products contribute to pulmonary arterial hypertension? Am J Physiol Heart Circ Physiol 2019; 317:H1093-H1101. [PMID: 31490732 DOI: 10.1152/ajpheart.00416.2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a fatal disease with a median survival of only 5-7 yr. PAH is characterized by remodeling of the pulmonary vasculature causing reduced pulmonary arterial compliance (PAC) and increased pulmonary vascular resistance (PVR), ultimately resulting in right ventricular failure and death. Better therapies for PAH will require a paradigm shift in our understanding of the early pathophysiology. PAC decreases before there is an increase in the PVR. Unfortunately, present treatment has little effect on PAC. The loss of compliance correlates with extracellular matrix remodeling and fibrosis in the pulmonary vessels, which have been linked to chronic perivascular inflammation and immune dysregulation. However, what initiates the perivascular inflammation and immune dysregulation in PAH is unclear. Alteration of the gut microbiota composition and function underlies the level of immunopathogenic involvement in several diseases, including atherosclerosis, obesity, diabetes mellitus, and depression, among others. In this review, we discuss evidence that raises the possibility of an etiologic role for changes in the gut and circulating microbiome in the initiation of perivascular inflammation in the early pathogenesis of PAH.
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Affiliation(s)
- Thenappan Thenappan
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Alexander Khoruts
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Immunology, University of Minnesota, Minneapolis, Minnesota.,BioTechnology Institute, University of Minnesota, Minneapolis, Minnesota
| | - Yingjie Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - E Kenneth Weir
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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Păcurar D, Dijmărescu I, Dijmărescu AD, Romaşcanu M, Becheanu CA. A case report on an incidental discovery of congenital portosystemic shunt. Medicine (Baltimore) 2019; 98:e16679. [PMID: 31374048 PMCID: PMC6709057 DOI: 10.1097/md.0000000000016679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the portal blood to drain directly into the systemic circulation, eluding the liver. These shunts arise through disturbances in the embryonic development. PATIENT CONCERNS A 9-year-old male patient was referred to our department for further evaluation of a vascular malformation which was diagnosed in another facility when the patient was 2 years old, following a routine abdominal ultrasound. The patient had no complaints and the physical examination was normal at all times. DIAGNOSIS Laboratory tests and esogastroduodenoscopy were normal. The abdominal ultrasound showed a side-to-side shunt between a short portal trunk and the inferior vena cava. A hepatic mass suggestive for focal noduar hyperplasia was seen in the left liver lobe. Abdominal angio-computed tomography (angio-CT) was performed and the ultrasonographic anomalies were confirmed. Multiple other vascular malformations were diagnosed-hepatic artery emerging from the superior mesenteric artery, with early division; hepatic veins forming a short common trunk before draining into the inferior vena cava; supranumerary right renal artery emerging from the aorta, tributary for the upper renal pole. Ecocardiography showed left superior vena cava persistence. The final diagnosis was Abernathy malformation type IB. In the meantime the patient was diagnosed with allergic asthma. INTERVENTIONS No surgical cure was pursued because the malformation was an incidental discovery. OUTCOMES The patient was followed-up closely from the final diagnosis (when he was 9 years old) to present (he is currently 10 years old) with no change in his status-he remained asymptomatic. LESSONS Angio-CT should be the performed whenever a vascular malformation is suspected in order to establish a correct diagnosis, because portosystemic shunts carry a high risk of severe complications. Knowing that patients with portosystemic shunts may have pulmonary hypertension, respiratory complaints should be carefully evaluated-in this particular case, even though the most probable cause for the respiratory symptoms was pulmonary hypertension, it was ruled out by cardiac ultrasonography and further investigations confirmed the diagnosis of allergic asthma.
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Affiliation(s)
- Daniela Păcurar
- “Grigore Alexandrescu” Emergency Children's Hospital
- “Carol Davila” University of Medicine and Pharmacy
| | - Irina Dijmărescu
- “Grigore Alexandrescu” Emergency Children's Hospital
- “Carol Davila” University of Medicine and Pharmacy
| | | | | | - Cristina Adriana Becheanu
- “Grigore Alexandrescu” Emergency Children's Hospital
- “Carol Davila” University of Medicine and Pharmacy
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Azad S, Arya A, Sitaraman R, Garg A. Abernethy malformation: Our experience from a tertiary cardiac care center and review of literature. Ann Pediatr Cardiol 2019; 12:240-247. [PMID: 31516281 PMCID: PMC6716315 DOI: 10.4103/apc.apc_185_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Abernethy malformation, also called as congenital extrahepatic portosystemic venous shunt, is a rare anomaly involving the portal venous system. Although rare, it is increasingly being reported and is important to diagnose given the adverse clinical consequences in untreated patients. It has myriad of clinical presentations, from being completely asymptomatic to causing hepatic carcinoma, hepatic encephalopathy, severe pulmonary hypertension, and diffuse pulmonary arteriovenous malformation. We describe our experience with five cases in a tertiary pediatric cardiac care center with Abernethy malformation, with review of literature and also discuss possible therapeutic implications.
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Affiliation(s)
- Sushil Azad
- Department of Pediatric Cardiology and Congenital Heart Disease, Fortis Escorts Heart Institute, New Delhi, India
| | - Adhi Arya
- Department of Pediatric Cardiology and Congenital Heart Disease, Fortis Escorts Heart Institute, New Delhi, India
| | - Radhakrishnan Sitaraman
- Department of Pediatric Cardiology and Congenital Heart Disease, Fortis Escorts Heart Institute, New Delhi, India
| | - Amit Garg
- Department of Radiodiagnosis, Fortis Escorts Heart Institute, New Delhi, India
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