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Mesoatrial shunt in Budd-Chiari syndrome
1Department of General Surgery, Hepatopancreatobiliary Surgery Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Background:
The operations with proven effects on survival in Budd-Chiari syndrome are shunt operations and liver transplantation.
Patients And Methods:
Between 1993 and 1999 (June), 13 cases of Budd-Chiari syndrome have been treated surgically. Four cases had concomitant thrombosis of the inferior vena cava; the others had marked narrowing of the lumen due to the enlarged caudate lobe. Mesoatrial (n = 12) or mesosuperior vena caval (n = 1) shunts were constructed with ringed polytetrafluoroethylene grafts.
Results:
The median portal pressure fell from 45 (range 32 to 55) to 20 (range 11 to 27) cm H(2)O (P <0.001). Two patients died in the early postoperative period. One patient who did not comply with anticoagulant treatment had a shunt thrombosis in the second postoperative year. The other 10 patients are alive without problems during a median 42 (range 1 to 76) months of follow-up.
Conclusion:
Mesoatrial shunt with a ringed polytetrafluoroethylene graft is effective in Budd-Chiari syndrome cases with thrombosis or significant stenosis in the inferior vena cava.