Anastomosis between the middle and right hepatic vein

Now, the need for preservation and reconstruction of the middle hepatic vein tributaries in the right liver graft without middle hepatic vein or in the remnant liver in the donor using left liver graft with middle hepatic vein has not been confirmed. Congestion depends on the intrahepatic communicating hepatic veins. We report herein the case of a 54-year-old man who had been the donor in a living-related liver transplantation and underwent extended left hepatectomy including the middle hepatic vein. His remnant right hepatic lobe was drained by the right hepatic vein, so the anterior segment was likely to be congested after hepatectomy. However, it had not been congested in fact. We observed blood flow with an antegrade biphasic waveform, which was "a mirror image of the hepatic venous waveform", in the branch of middle hepatic vein in the remnant liver using left liver graft with middle hepatic vein. We recognized that the branch of middle hepatic vein had functioned as an effective drainage vein. Indeed, reconstruction of the middle hepatic vein tributaries was not needed in this case. "The mirror image of hepatic venous waveform" is an important sign that indicates adequate drainage blood flow.