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Related Experiment Videos

Accessory hepatic vein complicating extra-cardiac total cavopulmonary connection.

Shinpei Yoshii1, Shoji Suzuki, Hiroshi Osawa

  • 1Department of Surgery, Yamanashi Medical University, Tamaho-cho, Nakakoma-gun, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|May 25, 2002
PubMed
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Severe hypoxia occurred post-cardiac surgery in a child with polysplenia and complex heart defects. Ligation of an accessory hepatic vein resolved the hypoxia, highlighting its importance in extra-cardiac total cavopulmonary connections.

Area of Science:

  • Cardiology
  • Pediatric Surgery
  • Vascular Anatomy

Background:

  • A 2-year-old girl with polysplenia presented with complex congenital heart disease, including single atrium, single ventricle, pulmonary stenosis, and malposition of great arteries.
  • The patient underwent a total cavopulmonary shunt followed by an extra-cardiac total cavopulmonary connection using a tube graft.

Observation:

  • Postoperatively, the patient developed severe hypoxia, necessitating further investigation.
  • Angiography revealed contrast medium flowing from the conduit into the hepatic vein, then via intrahepatic communications to an accessory hepatic vein directly connected to the atrium.

Findings:

  • The accessory hepatic vein was identified as the cause of the hypoxia by shunting blood away from pulmonary circulation.
  • Ligation of the accessory hepatic vein within the pericardial cavity successfully resolved the hypoxia and prevented hepatic dysfunction.

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Implications:

  • This case underscores the critical need for surgeons to consider the presence of accessory hepatic veins during extra-cardiac total cavopulmonary connection procedures.
  • Awareness and identification of anomalous hepatic venous drainage are crucial for preventing postoperative complications like severe hypoxia in complex pediatric cardiac surgery.