Multistage closure of a congenital extrahepatic portosystemic shunt

Abstract Background Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS. Case presentation A 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed. Conclusion This paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment. Level of Evidence: Level 4, Case report.

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Surgical Ligation of Extrahepatic Shunt under Guidance of Doppler Ultrasound, Portography, and Portal Pressure Monitoring

Case Reports in Surgery ◽

10.1155/2012/346759 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Mitsugi Shimoda ◽

Takayuki Shimizu ◽

Keiichi Kubota

Keyword(s):

Doppler Ultrasound ◽

Portal Pressure ◽

Vena Cava ◽

Flow Speed ◽

Portosystemic Shunt ◽

Portal System ◽

Pressure Monitoring ◽

Portal Flow ◽

Surgical Ligation ◽

Disturbance Of Consciousness

A 54-year-old man with chronic hepatitis C was admitted to our hospital because of a disturbance of consciousness and hyperammonemia. Abdominal angiography revealed a portosystemic shunt between the superior mesenteric vein and inferior vena cava. Endoscopic examination showed no varix. As interventional treatment was unsuccessful, surgical ligation of the shunt was performed. After surgery, portography revealed a huge shunt. Before ligation, the portal pressure, portal flow speed, and volume at the umbilical portion were 24 H2O. 5.6 cm/s and 203 ml/min, respectively. Finally the shunt was ligated. The portal flow speed and volume increased for 14 days following surgery and then stabilized. No varices were observed postoperatively. Doppler ultrasound, portography, and portal pressure monitoring can be used to reveal haemodynamic changes in the portal system and justify surgical ligation of portosystemic shunt.

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Single-Patch Fold-Back Technique for Augmentation of the Superior Vena Cava in Sinus Venosus Atrial Septal Defect Associated with Partial Anomalous Pulmonary Venous Return

The Heart Surgery Forum ◽

10.1532/hsf98.2014433 ◽

2015 ◽

Vol 17 (6) ◽

pp. 282

Author(s):

Suguru Ohira ◽

Kiyoshi Doi ◽

Takeshi Nakamura ◽

Hitoshi Yaku

Keyword(s):

Atrial Septal Defect ◽

Superior Vena Cava ◽

Septal Defect ◽

Venous Return ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Sinus Venosus ◽

Right Atrial ◽

Anomalous Pulmonary Venous Return

Sinus venosus atrial septal defect (ASD) is usually associated with partial anomalous pulmonary venous return (PAPVR) of the right pulmonary veins to the superior vena cava (SVC), or to the SVC-right atrial junction. Standard procedure for repair of this defect is a patch roofing of the sinus venosus ASD and rerouting of pulmonary veins. However, the presence of SVC stenosis is a complication of this technique, and SVC augmentation is necessary in some cases. We present a simple technique for concomitant closure of sinus venosus ASD associated with PAPVR and augmentation of the SVC with a single autologous pericardial patch.

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Atrial Septal Defect Closure via Left Subclavian Vein Approach in a Patient With Absent Inferior Vena Cava

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120983807 ◽

2021 ◽

pp. 215013512098380

Author(s):

Yusuke Enta ◽

Shunsuke Tatebe ◽

Yoshikatsu Saiki ◽

Norio Tada

Keyword(s):

Inferior Vena Cava ◽

Atrial Septal Defect ◽

Subclavian Vein ◽

Septal Defect ◽

Inferior Vena ◽

Transcatheter Closure ◽

Vena Cava ◽

Atrial Septal Defect Closure ◽

Azygos Continuation ◽

Left Subclavian Vein

Without the femoral venous approach, transcatheter closure of an atrial septal defect is challenging. We performed percutaneous closure via the left subclavian vein in a patient with absence of the inferior vena cava with azygos continuation. Considering that inferior vena cava anomalies are not extremely rare among those with congenital heart disease, the left subclavian vein approach can be an alternative to the femoral approach.

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P649 Before and after: sinus venosus atrial septal defect

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.331 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Marco Clement ◽

R Eiros ◽

R Dalmau ◽

T Lopez ◽

G Guzman ◽

...

Keyword(s):

Atrial Septal Defect ◽

Left Atrium ◽

Atrial Flutter ◽

Superior Vena Cava ◽

Right Atrium ◽

Septal Defect ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

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