No abstract available.
Portacaval Shunt, Surgical*

A device of extrahepatic portacaval shunt is introduced. This device is composed of the daughter and parent magnets and the vascular interventional operation equipment. It is based on the principle of magnetic compression technology, through the intervention approach the daughter and mother magnet are moved to the portal vein and inferior vena cava, respectively. Then the two magnets attract and compress the vessel walls of portal vein and inferior vena cava. Two weeks later, the magnets are detached from the vessel wall with a RUPS-set and the portacaval shunt is established. It is mainly used for the treatment of portal hypertension. It belongs to the interventional operation, there is no any foreign body remaining after the portacaval shunt is established, which can maintain long-term patency. Futhermore the portacaval shunt will not be expanded, therefore it can significantly reduce the incidence of hepatic encephalopathy.
Equipment Design ; Magnetics ; Portacaval Shunt, Surgical ; instrumentation

OBJECTIVETo evaluate the effects of portaazygous disconnection (PAD), portacaval shunt (PCS) and distal splenocaval shunt (DSCS) on the portosytemic shunting (PSS), hepatic function (HF), hepatic mitochondrial respiratory function (HMRF), oral glucose tolerance test (OGTT) and arterial ketone body ratio (KBR) in order to provide a sound basis for selecting suitable operations for patients.

METHODSUsing a cirrhotic portal hypertensive model induced by CCl4/ethanol in Wistar rats, the PSS, HF, HMRF, OGTT and KBR were determined three weeks after PCS, DSCS and PAD.

RESULTSIt was revealed that: (1) In the cirrhotic portal hypertension rats, the PSS increased significantly, HMRF and hepatic reserve function (HRF) decreased significantly when compared with the control rats. (2) At the time of first postoperative week, the mean blood glucose value in the 120-minute OGTT in each PAD, PCS and DSCS groups had significant differences compared with the cirrhotic control group. But during the second and third postoperative weeks, the mean blood glucose values in the 120-minute OGTT in both PAD and DSCS groups had no significant differences compared with the cirrhotic control group except for the PCS group. The values of KBR in the three operative groups decreased significantly compared with the cirrhotic control group during the two postoperative weeks. In the third postoperative week, only the values of KBR in the PCS group had a significant difference compared with the cirrhotic control group. (3) After PCS, the PSS was further increased; HF and HMRF were significantly decreased. Little improvement was found in the third postoperative week. (4) After DSCS and PAD, the above mentioned indices were less influenced, and they were restored more quickly than those in the PCS group.

CONCLUSIONWe found that PAD and DSCS are more desirable than PCS.

Animals ; Hypertension, Portal ; etiology ; surgery ; Liver Cirrhosis, Experimental ; complications ; surgery ; Portacaval Shunt, Surgical ; Portasystemic Shunt, Surgical ; methods ; Rats ; Rats, Wistar

PURPOSE: To investigate the changes occurring in portal hemodynamics in patients with esophageal and gastric varices, according to variceal type, before and after TIPS. MATERIALS AND METHODS: Between January 1994 and June 1999, we evaluated 22 of 44 patients who had undergone TIPS and endoscopy on admission. In these 22, hepatic venous and main portal venous pressure were measured. On the basis of endoscpic findings, the esophageal and gastric varices were classified as one of three types. Changes in portal hemodynamics in relation to the diameter of the portal vein, mean portosystemic gradient before and after TIPS, delta MPSG, and the presence of hepatic encephalopathy and gastrorenal shunt were all evaluated. RESULTS: Endoscopy indicated that there were ten Type-I cases, nine Type-II, and three Type-III. The diameter of the main portal vein was 14.95 +/-1.79 mm in Type I cases, and 13.35 +/-1.59 mm in Type II. Before TIPS, main portal venous pressure was 31.40 +/-6.79 mmHg (Type I) and 22.80 +/-4.26 mmHg (Type II), and the mean portosystemic gradient was 16.10 +/-7.0 mmHg (Type I), and 11.20 +/-5.36 mmHg (Type II). After TIPS, the pressure readings were 25.70 +/-7.60 mmHg (Type I) and 17.80 +/-6.52 mmHg (Type II), while those relating to were 10.80 +/-4.94 mmHg (Type I) and 5.25 +/-3.67 mmHg (Type II). delta MPSG was 6.04 +/-2.98 mmHg (Type I) and 5.91 +/-3.98 mmHg (Type II). Angiography revealed that the gastrorenal shunt was Type I in 10% of cases, Type II in 77%, and Type III in 33%. Hepatic encephalopathy after TIPS occured in three Type-I cases, three-Type- II, and two Type-III. CONCLUSION: The diameter of the main portal vein was significantly smaller, and portal venous pressure and mean portosystemic gradient before and after TIPS significantly lower in patients with dominant gastric varices than in those with dominant esophageal varices (p<0.05). Gastrorenal shunt was more frequent among patients with dominant gastric varices. No difference in the incidence of hepatic encephalopathy after TIPS was noted between those with dominant gastric varices and those with the esophageal variety.
Angiography ; Endoscopy ; Esophageal and Gastric Varices* ; Hemodynamics* ; Hepatic Encephalopathy ; Humans ; Incidence ; Portacaval Shunt, Surgical ; Portal Pressure ; Portal Vein ; Portasystemic Shunt, Surgical* ; Reading

PURPOSE: In liver transplantation, low portal perfusion pressure may result in underperfusion of grafts and be the cause of primary nonfunction. Partial arterialization of portal vein could preserve graft perfusion. Up till now, there have been several clinical cases of temporary or permanent portal arterialization in liver transplantation. METHODS: In this study, we designed rat model for evaluating the effect of portal arterialization to improve survival of the under-perfused graft. Partial heterotopic non-regenerative liver transplantation was used with portal inflow only from inferior vena cava, which is known as portal under-perfusing liver transplantation model. Partial portal arterialization was performed by fenestration of the common wall between the IVC and the aorta through venotomy which was made for portacaval anastomosis. RESULTS: Immediate after arterialization, satisfactory macroscopic and duplex ultrasonographic liver perfusion were seen and the arterialized-graft survival was significantly improved to 95% (19/20) vs. 35% (7/20) of nonarterialized grafts. At 2-week after transplantation, the arterialized liver graft was atrophied showed normal gross appearance. The histopathologic examination with light microscope revealed no significant pathologic abnormality. CONCLUSION: Partial portal arteria;ization improved graft-survival of the under-perfusing liver grafts significantly and not affects the histologic hepatic structure adversely.
Aorta ; Graft Survival* ; Liver Transplantation* ; Liver* ; Models, Animal ; Perfusion ; Portacaval Shunt, Surgical ; Portal Vein ; Transplants* ; Vena Cava, Inferior

BACKGROUNDPortasystemic shunts, especially total shunts, are effective tools for reducing portal pressure and controlling variceal bleeding but lead to high risk of encephalopathy and accelerating liver failure. The purpose of this study is to evaluate the clinical effects of small-diameter expanded polytetrafluoroethylene (ePTFE) H-graft portacaval shunts in the treatment of portal hypertension.

METHODSThirty-one patients with portal hypertension were treated with ePTFE small-diameter H-graft portacaval shunts from December 1995 to April 2002. Twenty-one had externally ringed grafts and 10 had non-ringed grafts; 20 had 10 mm diameter grafts and 11 had 8 mm grafts. The left gastric artery and coronary vein were ligated in 22 patients. Additionally, 6 patients underwent pericardial devascularization, and splenectomies were performed on 30 patients.

RESULTSAn average decrease of free portal pressure (FPP) from (32.13 +/- 4.86) cmH2O before shunting to (12.55 +/- 5.57) cmH2O after shunting was observed. Portal blood flow was reduced by 1/3 compared with the levels measured before shunting. Twenty-eight patients survived after the operation, and no upper gastrointestinal rebleeding occurred in the follow-up period (40.2 months on average). We lost contact with one patient. Color Doppler ultrasonography and/or portography revealed the shunts to be patent in 28 cases and occluded in 2 (6.4%) cases. Encephalopathy developed in 4 patients (12.9%).

CONCLUSIONSmall-diameter ePTFE H-graft portacaval shunts can effectively reduce portal pressure. Moreover, the majority of the hepatopetal flow from the portal vein can be adequately maintained. The reinforced shunts may achieve a higher rate of patency. Morbidity from encephalopathy was less frequent than in patients receiving total shunts. Small-diameter H-graft portacaval shunts are also effective in preventing recurrent variceal bleeding.

Adult ; Blood Vessel Prosthesis ; Female ; Humans ; Hypertension, Portal ; surgery ; Male ; Middle Aged ; Polytetrafluoroethylene ; Portacaval Shunt, Surgical ; methods ; Treatment Outcome

Since the fast expansion of living donor liver transplantation (LDLT) over last few decades, small-for-size syndrome (SFSS) has emerged as a tough problem. Herein the first case of LDLT combined hemi-portocaval shunt in the mainland of China was reported. Portal venous over perfusion was well modulated and the recipient recovered uneventfully. LDLT combined hemi-portocaval shunt was a feasible procedure for preventing SFSS in LDLT.
Adult ; Carcinoma, Hepatocellular ; surgery ; Humans ; Liver Neoplasms ; surgery ; Liver Transplantation ; methods ; Living Donors ; Male ; Portacaval Shunt, Surgical ; methods

The Budd-Chiari syndrome is no longer a rare disease in the world, but there has been small cases reported until now in Korea. There are three forms of Budd-Chiari syndrome, among them membranous web in the inferior vena cava is the most common form in the oriental area. Authors have expereinced the Budd-Chiari syndrome, 49 year old female patient, caused by membranous web associated with the long thrombus in the inferior vena cava. She underwent side-to-side portacaval shunt and cavoatrial shunt using 19 mm diameter, 25 cm length polytetrafluoroetylene graft. Postoperative major morbidities were ARF and pneumonia. She has improved clinically and pathologically after operation. It is concluded that combined portacaval shunt and cavoatrial shunt has been effective to relieve the symptoms of Budd-Chiari syndrome caused by membranous web and inferior vena cava thrombotic occlusion.
Budd-Chiari Syndrome ; Female ; Humans ; Korea ; Middle Aged ; Pneumonia ; Portacaval Shunt, Surgical ; Rare Diseases ; Thrombosis ; Transplants ; Vena Cava, Inferior

portacaval shunt operation were found to be the risk factors for hepatic adenoma development. The hepatocellular carcinoma-free survival rate at 10 years from adenoma development was 82%.CONCLUSION: The present study found that portacaval shunt operation increases the risk of development of hepatic adenoma in GSD patients, especially in GSD type I. The hepatic adenoma in GSD patients has a potential of malignant transformation, which should be keep in mind in follow-up process of the disease.]]>
Adenoma ; Carcinoma, Hepatocellular ; Diagnosis ; Follow-Up Studies ; Glucose ; Glycogen Storage Disease ; Glycogen ; Humans ; Metabolism ; Portacaval Shunt, Surgical ; Retrospective Studies ; Risk Factors ; Seoul ; Survival Rate

OBJECTIVE: A few years ago it was shown that uncooked cornstarch feeding(UCS) could correct the biochemical abnormalities resulting from a deficiency of glucose-6-phosphatase in children with type ment. So far, little experience is available with UCS in Korea. We studied to compare the effects on biochemical control and growth of therapy with portacaval shunt and therapy with UCS. METHODS: Enghteen patients with GSD-I, ranging in age from 2 to 17 years, were included in these studies. They were thirteen male and five female children, and were diagnosed as GSD-I in Seoul National University from 1982 to 1994. Six patients (age 6.75+/-3.06, range 4.33~12.75 years) received portacaval shunt after preoperative intravenous hyperalimentation, and fifteen patients(age 7.08+/-4.09, rnage 2.00~17.00years) received UCS(1.75~2g/kg, four times daily). They included three patients who have had hepatic adenoma during follow-up after portacaval shunt. Height standard deviation score(SDS), liver size, blood glucose, serum cholesterol, serum uric acid, and serum transaminase were measured. RESULTS: After UCS, the changes of height SDS, liver size, blood glucose, and serum uric acid were significant but the changes of cholesterol, SGOT, and SGPT were not significant. The SDS of height increased significantly form -2.61+/-1.01 at onset of UCS to -1.93+/-0.86 after UCS. The liver size decreased significantly form 10.1+/-2.7cm at onset of UCS to 7.9+/-3.0cm after UCS. Blood glucose levels increased significantly form 50.6+/-14.3mg/dl at onset of UCS to 90.1+/-17.0mg/dl after UCS. Serum uric acid levels decreased significantly form 8.03+/-2.12mg/dl at onset of UCS to 5.67+/-2.34mg/dl after UCS. Statistically, significant difference were not found in those values after portacaval shunt. CONCLUSIONS: UCS was effective to maintain blood glucose, to minimize biochemical abnormalities and to optimize clinical outcome in patients with GSD. Individuals with GSD-I commonly developed hepatic adenoma and malignant transformation of these ademonas has occurred. So in any case, it is advisable to screen all GSD-I patients periodically by imaging techniques for tumor formation, and once tumors have been detected, to adopt strict dietary measures and observe them closely for evidence of suggestive malignant transformation.
Adenoma ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Glucose ; Child ; Cholesterol ; Female ; Follow-Up Studies ; Glucose-6-Phosphatase ; Glycogen Storage Disease ; Humans ; Korea ; Liver ; Male ; Parenteral Nutrition, Total ; Portacaval Shunt, Surgical ; Seoul ; Starch* ; Uric Acid