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Hepatoatrial anastomosis and tricuspid valve replacement in Budd-Chiari syndrome 8
C K Chiu1, D M Nagorney, H V Schaff
1Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Insights
A rare complication of peritoneovenous shunt displacement caused tricuspid valve stenosis in Budd-Chiari syndrome. Surgical intervention involved shunt removal, tricuspid valve replacement, and hepatoatrial anastomosis to restore blood flow.
Area of Science:
- Cardiovascular Surgery
- Hepatology
- Medical Device Complications
Background:
- Budd-Chiari syndrome, a rare condition, involves hepatic vein obstruction.
- Peritoneovenous shunts are used to manage ascites in liver disease.
- Tricuspid valve stenosis is a potential, though uncommon, complication of shunts.
Observation:
- A patient with Budd-Chiari syndrome developed tricuspid valve stenosis.
- The stenosis was attributed to the displacement of a peritoneovenous shunt catheter.
- This highlights a rare but serious complication of peritoneovenous shunting.
Findings:
- Surgical management was performed, including shunt removal.
- Tricuspid valve replacement with a bioprosthesis was necessary.
- Hepatoatrial anastomosis was created, and liver resection addressed hepatic vein stenosis.
Implications:
- Successful surgical intervention restored physiologic hepatic venous blood flow.
- This case demonstrates a complex management strategy for a rare complication.
- Highlights the importance of monitoring for shunt-related complications in liver disease patients.
Abstract:
The rare complication of tricuspid valve stenosis due to displacement of a peritoneovenous shunt catheter developed in a patient with Budd-Chiari syndrome. Surgical management included shunt removal and tricuspid valve replacement combined with hepatoatrial anastomosis. The tricuspid valve was replaced with a bioprosthesis, and liver resection opened the stenotic confluence of the hepatic veins. The right atrium was sutured to the liver capsule, thereby restoring physiologic hepatic venous blood flow.