A Very Rare Venous Anomaly in a Living Liver Donor: Left Hepatic Venous Connection to the Right Atrium

Pulmonary embolism (PE) is a rare but potentially fatal complication that may develop in a living liver donor. Here, we report a case of non-massive PE diagnosed by elevated serum D-dimer levels and successfully treated using anticoagulant therapy. A 57-year-old man underwent extended left hepatectomy as a living liver donor. His past medical history included hypertension and dyslipidemia which required medication and a history of smoking. Mechanical prophylactic measures for venous thromboembolism, including intermittent pneumatic compression and elastic stocking, were used; however, no pharmacological prophylaxis was used. Although the patient ambulated on postoperative day (POD) 1, he developed hypoxia. Serum D-dimer level was elevated to 29.3 ng/mL on POD 2. Enhanced computed tomography revealed small peripheral PEs in the branches of the right upper, right middle, and left lower lobes without deep vein thrombosis. Intravenous heparin was initiated followed by warfarin. The thrombi resolved completely by POD 13, following which warfarin was continued for 3 months. As of 25 months after donation, the patient remains well without recurrence of PE. Early diagnosis and treatment of postoperative PE are critical for preventing mortality of liver donors.

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Special considerations of living liver donor transplantation

Orvosi Hetilap ◽

10.1556/oh.2013.29698 ◽

2013 ◽

Vol 154 (36) ◽

pp. 1417-1425

Author(s):

Attila Szijártó ◽

Yasuhiro Fujimoto ◽

Kirino Izumi ◽

Uemoto Shinji

Keyword(s):

Hepatic Vein ◽

Middle Hepatic Vein ◽

Liver Donor ◽

Liver Lobe ◽

Left Liver Lobe ◽

Average Value ◽

Living Liver Donor ◽

The Right ◽

Disparity Index ◽

Right Hepatic Vein

Introduction: Due to the limited number of cadaver donors, adult living liver donor transplantation became an alternative for liver transplantation. During living liver donor transplantation, the safety and uncomplicated recovery of the donor are as important as the appropriate volume and weight of the donated graft. The middle hepatic vein causes a significant dilemma, due to the special anatomical position. The reconstruction of the middle hepatic vein branches supplying S5, S8 is suggested when the anatomically right liver lobe is transplanted. Aim: The aim of the present study was to investigate the requirements of the reconstruction of middle hepatic vein and to give an accurate description about the discrepancy between the portal vein in- and outflow. Method: The authors analyzed the liver anatomic characteristics of 130 donors undergoing living liver donor transplantation with the use of MeVis software. The so-called porto-hepatic disparity index (shift) was introduced. Results: The right hepatic vein was dominant in 64.6% of all cases, while the left hepatic vein was never observed to be dominant. The territories of V5 and V8 were responsible for the 33.2±8.9% of the right hepatic lobe area. The correlation between portal venous territory and vein dominancy were as follows: R2= 0.7811 in the left liver lobe; R² = 0.5463 in the area of middle hepatic vein and R² = 0.5843 in the case of the right hepatic vein. The average value of the shift was 28.2%. Conclusions: The differences among the pattern of portal in- and hepatic outflow is an important issue that should be taken into consideration when deciding the necessity for reconstruction of the middle hepatic vein. Orv. Hetil., 2013, 154, 1417–1425.

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Two-dimensional Echocardiographic and Color Flow Doppler Detection of an Unusual Pulmonary Venous Anomaly: Anomalous Right Pulmonary Venous Return to the Right Atrium by Way of Three Separate Orifices

Journal of the American Society of Echocardiography ◽

10.1016/s0894-7317(14)80507-5 ◽

1990 ◽

Vol 3 (2) ◽

pp. 135-139 ◽

Cited By ~ 2

Author(s):

Roger P. Vermilion ◽

A. Rebecca Snider ◽

Jane A. Peters ◽

Lyne M. Merida-Asmus

Keyword(s):

Right Atrium ◽

Venous Return ◽

Two Dimensional ◽

Venous Anomaly ◽

Color Flow ◽

The Right

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Rare Portal Venous Anomaly in a Living Liver Donor: A Case Report

Transplantation Proceedings ◽

10.1016/j.transproceed.2021.08.009 ◽

2021 ◽

Author(s):

Katsunori Sakamoto ◽

Kohei Ogawa ◽

Kei Tamura ◽

Chihiro Ito ◽

Miku Iwata ◽

...

Keyword(s):

Case Report ◽

Venous Anomaly ◽

Liver Donor ◽

Living Liver Donor

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WITHDRAWN: Enlargement of the Right Atrium – Diverticulum or Aneurysm?

European Journal of Echocardiography ◽

10.1053/euje.2002.0629 ◽

2002 ◽

Author(s):

R KOBZA ◽

E OECHSLIN ◽

R PRETRE ◽

D KURZ ◽

R JENNI

Keyword(s):

Right Atrium ◽

The Right

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Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

The Heart Surgery Forum ◽

10.1532/hsf98.20041173 ◽

2005 ◽

Vol 8 (2) ◽

pp. 96 ◽

Cited By ~ 1

Author(s):

Osman Tansel Dar�in ◽

Alper Sami Kunt ◽

Mehmet Halit Andac

Keyword(s):

Atrial Septal Defect ◽

Right Atrium ◽

Septal Defect ◽

Complete Recovery ◽

Interatrial Septum ◽

Right Atrial ◽

Atrial Wall ◽

Residual Shunt ◽

Asd Closure ◽

The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

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