Liver transplantation in the setting of a spontaneous shunt between superior mesenteric vein and right renal vein
| Autor: | João E Prediger, Sofia Zahler, Marcio F. Chedid, Angelo Zanin D'angelo Giampaoli, Tomaz J. M. Grezzana-Filho, Aljamir Duarte Chedid, Cleber Rosito Pinto Kruel, Bruno de Brito Lopes, Ian Leipnitz |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Cirrhosis medicine.medical_treatment Specialties of internal medicine Right renal vein Liver transplantation 03 medical and health sciences 0302 clinical medicine medicine Spontaneous shunt Thrombus Superior mesenteric vein Hepatology business.industry General Medicine medicine.disease Thrombosis Surgery RC581-951 030220 oncology & carcinogenesis Portal vein Arterial line 030211 gastroenterology & hepatology business Ligation Shunt (electrical) |
| Zdroj: | Annals of Hepatology, Vol 19, Iss 3, Pp 335-337 (2020) |
| ISSN: | 1665-2681 |
| Popis: | Shunts between the superior mesenteric vein (SMV) and the right renal vein (RRV) are very rare. Here, we describe and depict the rare case of a liver transplant (LT) in the setting of shunt between SMV and RRV. A 67-year-old white man presenting with Child C cirrhosis secondary to hemochromatosis and persistent encephalopathy was listed for LT. Preoperative abdominal angiotomography revealed the presence of a large spontaneous shunt between the SMV and the RRV. The patient underwent LT by receiving a liver from a 17-year-old brain-dead deceased donor victim of trauma. A large shunt between the SMV and the RRV was confirmed intraoperatively. Although there was no portal vein (PV) thrombosis, the PV was atrophic and had a reduced flow. PV pressure was 22 mmHg (an arterial line was inserted inside the PV stump, and this line was connected to a common pressure transducer, the pressure readings was expressed in the anesthesia monitor). After shunt ligation PV pressure increased to 32 mmHg. There were no post-transplant vascular complications, and the patient was discharged home in good health. Preoperative study of all LT candidates with angio CT scan is mandatory. Whenever there is PV thrombosis, an attempt to remove the entire thrombus is warranted. After thrombectomy or whenever there is not PV thrombosis, all large shunts should be ligated. PV pressure and flow should be measured before and after shunt ligation. In the absence of PV thrombosis, ligation of the shunt should enable an increase in PV flow and pressure, as reported herein. |
| Databáze: | OpenAIRE |
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