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Singh T, Rose S, Kalra N, Duseja A. Regenerative nodules as harbinger of Abernethy malformation. BMJ Case Rep 2023; 16:e258634. [PMID: 38061860 PMCID: PMC10711878 DOI: 10.1136/bcr-2023-258634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Tarvinder Singh
- Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sweta Rose
- Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Lin Y, Li X, Li S, Ba H, Wang H, Zhu L. Treatment Option for Abernethy Malformation-Two Cases Report and Review of the Literature. Front Pediatr 2020; 8:497447. [PMID: 33194880 PMCID: PMC7652759 DOI: 10.3389/fped.2020.497447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Abernethy malformation is a rare vascular anomaly of the portal venous system, which is also known as congenital portosystemic shunts (CPSS). The clinical manifestations of this anomaly can be serious, including hepatopulmonary syndrome(HPS), which can lead to significant hypoxemia and cyanosis. Case Presentation: This study reports two cases of patients with Abernethy Malformation. Case 1 was a 6-year-old boy whose blood oxygen saturation was 78%. Case 2 was a 6-year-old girl who had a history of open heart surgery and residual cardiac left to right shunt, whose blood oxygen saturation was 83%. These two children had unexplained cyanosis and were diagnosed with pulmonary arteriovenous fistula by contrast echocardiography with agitated saline. A selective retrograde catheter angiography confirmed the presence of a portosystemic shunt. Case 1 was a type I Abernethy malformation and did not receive any specific treatment and could only wait for liver transplantation. Case 2 was with type II Abernethy and underwent transcatheter closure of the CPSS. A 20mm-diameter, 14mm-long Vascular Plug (SHSMA Inc, Shanghai, China) was used to occlude the shunt. Results: In case 1, the boy developed deteriorating cyanosis and dyspnea on exertion. In case 2, the exercise tolerance of the patient improved after shunt closure. During a follow-up of 3 years, her blood oxygen saturation increased from 83 to 98%. Conclusion: The results indicate that children with unexplained cyanosis require special attention since these patients may have Abernethy malformation, and part of them could be treated by transcatheter occlusion with a good outcome. The key to treatment is how it is diagnosed and carefully assessed.
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Affiliation(s)
- Yuese Lin
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Xuandi Li
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Shujuan Li
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Hongjun Ba
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Huishen Wang
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Ling Zhu
- Department of Paediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
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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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Mesquita RD, Sousa M, Vilaverde F, Cardoso R. Abernethy malformation: beware in cases of unexplained hepatic encephalopathy in adults-case report and review of the relevant literature. BJR Case Rep 2017; 4:20170054. [PMID: 30363163 PMCID: PMC6159114 DOI: 10.1259/bjrcr.20170054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/13/2017] [Accepted: 10/25/2017] [Indexed: 01/04/2023] Open
Abstract
The Abernethy malformation consists of a congenital extrahepatic portosystemic shunt and is believed to be extremely rare in humans. The potential implications of abnormal portovenous shunting and decreased hepatic portal flow are numerous and potentially serious. Although congenital extrahepatic portosystemic shunts are increasingly suspected and diagnosed in specialized centres, much of their clinical presentation and natural history is not fully understood. Symptoms of portosystemic shunt are mainly caused by increased levels of ammonia, which lead to signs of encephalopathy. Therapeutic options depend on the type of shunt and its clinical course, so the classification of the congenital portosystemic shunt is a key finding in these patients.
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Affiliation(s)
- Romeu Duarte Mesquita
- Department of Radiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Marta Sousa
- Department of Radiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Rosa Cardoso
- Department of Radiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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