The evaluation of mesoatrial shunt patency with computed tomography

The mesoatrial shunt is performed in patients with the Budd-Chiari syndrome when the inferior vena cava is occluded and not available for a conventional portosystemic shunt. Computed tomography (CT), with injection of contrast media, was used to evaluate mesoatrial shunt patency with five examinations in four patients. Shunt patency was demonstrated by CT and confirmed by angiography in two studies. Total shunt occlusion diagnosed by CT in two additional cases was confirmed by angiography or operation. Partial graft occlusion diagnosed by CT in a fifth study was verified by both angiography and operation. CT is recommended instead of angiography in the evaluation of mesoatrial shunts because it is less invasive, it may be performed on an outpatient basis, and it yields additional useful information related to shunt patency, such as the volume of ascites, collateral vascularity, and the size of the spleen.