A new technique for the reconstruction of complex portal vein anomalies in right lobe living liver donors

Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor's safety and the complexity of reconstruction in the recipient. We describe an innovative technique to reconstruct double portal vein orifices via a deceased donor iliac vein graft. The postoperative course of the recipient was uneventful. Doppler ultrasound on the fourth postoperative month revealed equivalent flow in both portal vein branches. Reconstruction of double right portal vein branches using a cryopreserved iliac vein is a valuable technique for utilizing right lobe grafts with challenging portal vein anatomy.     

肝右静脉多普勒波形及门静脉右支血流速度诊断脂肪肝的临床价值

探讨彩色多普勒血流显像(CDFI)门静脉右支血流速度及肝右静脉多普勒波形诊断脂肪肝的临床价值。通过CDFI对2 80例脂肪肝的门静脉右支血流速度测定,观察其肝右静脉多普勒波形,并与4 5例正常肝组进行对比分析。结果发现,脂肪肝组的门静脉右支血流速度比正常明显降低,两组间比较有显著性差异(P <0 .0 5 )。脂肪肝患者的肝右静脉多普勒波形出现三种不同类型,其异常波形共占76 % ;而4 5例健康者肝右静脉多普勒形均为三相波形。脂肪肝组与正常组比较,肝右静脉多普勒频谱异常有显著性差异(P <0 .0 5 )。肝门静脉血流速度变化及肝右静脉多普勒频谱图异常有助于脂肪肝的早期诊断及预后判断。     

Versatility and viability of hepatic venoplasty in live donor liver transplantation using the right lobe with the middle hepatic vein

Including the middle hepatic vein in the right lobe liver graft has the advantage of providing direct venous drainage of the right anterior segment. To allow unimpeded passage of blood flow, we previously designed venoplasty of the middle and right hepatic veins. We found that venoplasty is also feasible when the inferior right hepatic vein is near to the right hepatic vein, or when multiple segment 8 hepatic vein orifices are exposed adjacent to the middle hepatic vein at the graft transection surface. By joining the hepatic vein orifices into a single opening, the anastomosis into the inferior vena cava is much facilitated. The technique is simple, yet versatile, and able to cope with variation of the configurations of the hepatic vein.     

A rare case of anomalous venous drainage of the right upper lobe

We present an unusual case of partial anomalous venous drainage in which the vein of the right upper lobe drains into the superior vena cava, together with the azygos vein. This was discovered during surgery for a lung tumor of the right upper lobe. We present the embryological background, functional consequences and literature on this rare anatomical anomaly.     

Anomalous unilateral single pulmonary vein mimicking partial anomalous pulmonary venous return

We report a case in which the clinical findings of a partial anomalous pulmonary venous return were present but with termination of the anomalous pulmonary vein into the left atrium. There was hypoplasia of the right lung, dextroposition of the heart, and a loop-like vascular density in the right lung field. Cardiac catheterization revealed no shunt, and on pulmonary angiograms, a large common right pulmonary vein draining the entire right lung and entering the left atrium by way of a single orifice. Possible embryologic explanations include atresia of the right inferior pulmonary vein and persistence of the ipsilateral superior pulmonary vein.     

Anomalous intrahepatic portal system in a patient with hilar bile duct cancer

We report a case of anomaly of the intrahepatic portal system in a 65-year-old man with hilar bile duct cancer. Preoperatively, percutaneous transhepatic portography demonstrated that there was a right posterior portal vein arising from the main portal vein. In addition, a large portal branch originated from the left portal vein and coursed toward the right hepatic lobe. Following portal embolization of the right posterior branch, the patient underwent an extended right hepatectomy with a caudate lobectomy. Intraoperatively, to the left at the porta hepatis and then it first gave off the right anterior portal vein originated from the left portal vein and coursed toward the right hepatic lobe horizontally behind the gallbladder and then separated into superior and inferior segmental branches to supply the right anterior segment of the liver. The ramification of some major branches without malposition of the gallbladder or round ligament was the important clinical feature of this anomaly.     

Hypoplastic Right Lung Associated with Right Pulmonary Vein Stenosis and Systemic Collateral

We present a case of a 6-month-old girl diagnosed as unilateral pulmonary vein stenosis (right inferior pulmonary vein) with dextroposition of the heart, hypoplastic right lung, hypoplastic right pulmonary artery, collateral from the descending aorta supplied right lower lung, connection between collateral and right pulmonary artery with retrograde flow from right pulmonary artery into main pulmonary artery, and right superior and middle pulmonary vein agenesis. A combined modality of imaging including chest film, echocardiography, multidector computerized tomography, and the cardiac catheterization nicely demonstrated all of the unique and rare congenital abnormalities.     

Successful liver allograft inflow reconstruction with the right gastroepiploic vein

Portal vein thrombosis is a common complica-tion in cirrhotic patients. When portal vein thrombectomy is not a suitable option, a large collateral vessel can be used for allograft venous inflow reconstruction. We describe an unusual case of successful portal revascularization using the right gastroepiploic vein. The patient underwent a cadaveric orthotopic liver transplantation with end-to-end anastomosis of the portal vein to the right gastroepiploic vein. Six months after liver transplantation the patient is well with good liver function. The use of the right gastroepiploic vein for allograft venous reconstruction is feasible and safe, with a great advan-tage of avoiding the need of venous jump graft.     

The right subclavian vein can be used as a surrogate of the inferior vena cava, as an echocardiographic indicator of systemic venous congestion

Respiratory variations in the caliber of the inferior vena cava, imaged in the subcostal view with the patient supine, correlated well with respiratory variation in the caliber of the right subclavian vein with the patient reclining at a 45 degrees angle. The subclavian vein was imaged by a right supraclavicular approach. We suggest that the right subclavian vein caliber be used as a surrogate of the inferior vena cava caliber when the latter cannot be used because of obesity, epigastric tenderness, or other reasons.     

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.     

A successful implantation of a dual-chambers cardioverter defibrillator for a patient with severe tortuous persistent left superior vena cava

We report a case of successful implantation of a dual-chambers transvenous cardioverter defibrillator for a dilated cardiomyopathy patient with severe tortuous persistent left superior vena cava and a very small innominate vein. After confirming the presence of a right superior vena cava, a dilated sheath was advanced into the narrow innominate vein to increase the lumen of innominate vein. The active atrial and ventricular leads were successfully inserted into right atrium and right ventricle through innominate bridge by the support of steerable long sheaths.     

Life made easy: simplifying reconstruction for dual portal veins in adult right lobe live donor liver transplantation

In live donor liver transplantation, anatomical anomalies of the portal vein are more frequently encountered in right lobe than left lobe grafts. Of these, a dual portal vein is one of the most common anatomical anomalies encountered. We hereby report our method of using a recipient portal vein patch after venoplasty for reconstruction in a right lobe graft with separate anterior and posterior portal vein branches.     

A case of liver cirrhosis with an unusual portosystemic shunt via the right testicular vein.

We report a case of liver cirrhosis with a rare portosystemic shunt via the right testicular vein. Angiographic examination demonstrated two major hepatofugal collateral pathways. First, the enlarged and tortous left gastric and short gastric veins which drain into the left renal vein after forming varices in the stomach. Second, the superior mesenteric vein forms the large mesenteric varices which drain into the inferior vena cava via the enlarged right testicular vein, which is a very rare shunt.     

Leiomyosarcoma of the inferior vena cava--an unusual case

Primary tumors arising from great vessels like the aorta, pulmonary artery or inferior vena cava (IVC) are rare. The latter is the commonest site of its occurrence. It arises from the smooth muscle cells of the vessel wall. Aggressive surgical management should be attempted to excise it whenever possible. We describe a case of primary inferior vena cava tumor involving all three segments of the abdominal inferior vena cava infrarenal, suprarenal and retrohepatic vena cava, along with right kidney, right adrenal as well as right hepatic vein and left renal vein. We resected it completely without reconstruction of the IVC. The patient is doing well seven months after surgery without having any renal insufficiency, hepatic insufficiency or leg edema and having optimum quality of life. To our knowledge, this is the first case of such a long segment IVC leiomyosarcoma treated without IVC reconstruction, and despite its extent and concomitant involvement of the right kidney, right adrenal, right hepatic vein and left renal vein, it had a favorable response combining prolongation of survival and satisfactory quality of life.     

Six-year survival following left hepatic trisectionectomy with simultaneous resection of the portal vein and right hepatic artery for advanced perihilar cholangiocarcinoma without lymph node metastases: report of a case

We report a case of survival for more than 6?years following left hepatic trisectionectomy and caudate lobectomy with simultaneous resection of the portal vein and right hepatic artery. The patient was a 65-year-old woman admitted to a local hospital with obstructive jaundice. The patient was diagnosed with perihilar cholangiocarcinoma and referred to our hospital. The tumor was located mainly in the left hilar region and occluded the left portal vein; furthermore, it involved the right portal vein and the right hepatic artery. The patient underwent left hepatic trisectionectomy and caudate lobectomy with simultaneous resection of the portal vein and right hepatic artery. The histological findings revealed that the tumor had invaded the portal vein and surrounded the right hepatic artery without any lymph node metastases. Microscopic curative (R0) resection was achieved. The patient is now healthy and still alive 6?years and 6?months after the surgery without any recurrence. Precise preoperative evaluation of the tumor and R0 resection by extended surgery contributed to a satisfactory outcome.     

Transhepatic portal vein access for balloon dilation of right upper pulmonary vein stenosis following infradiaphragmatic total anomalous pulmonary venous drainage repair

Transhepatic cardiac catheterization is now a well‐established alternative when conventional venous routes for cardiac access have failed. Some operators prefer this route even routinely, due to the direct access that it offers to the right atrium and atrial septum. We report the case of a newborn baby previously operated on for infradiaphragmatic total anomalous pulmonary venous drainage who represented with right sided pulmonary vein stenosis. Transhepatic portal vein access, first reported here, gave direct access to the right upper pulmonary vein, through the patent descending vein, after the conventional transfemoral venous and retrograde arterial routes had failed. © 2011 Wiley‐Liss, Inc.     

Right hepatic lobectomy and removal of inferior vena caval tumor embolus in a patient with hepatocellular carcinoma,using veno-venous bypass while preserving perfusion in the remnant liver: A case report

We describe a successful hepatectomy and the removal of a tumor embolus in a 43-year-old woman with hepatocellular carcinoma occupying the right lobe extending to the right branch of the portal vein and the inferior vena cava (IVC). Intraoperative echography revealed the tumor embolus in the IVC to originate from the main tumor via the right inferior hepatic vein, which extended cephalad from the confluence of the right hepatic vein to the IVC. Right hepatc lobectomy was performed via the anterior approach. Using femoro-axillary veno-venous bypass, we opened the IVC at the root of the inferior right hepatic vein to remove the tumor embolus after oblique clamping of the IVC between the right and middle hepatic veins was carried out to preserve perfusion in the remnant liver. Preserving perfusion in the remmant liver in radical hepatectomy for hepatocellular carcinoma with tumor embolism in the IVC appears to be a safe and advantageous technique in patients with poor liver reserve.     

Tissue Doppler echocardiography contribution to the diagnosis of upper extremities venous thrombosis

We present the case of a 35-year-old man with a history of beta-thalassemia complicated with heart failure who was admitted to our department because of right arm painful swelling. A transthoracic echo-Doppler study revealed a mass within the right jugular vein (RJV) lumen and absence of flow within the right subclavian vein (RSV). Subsequently, color tissue Doppler echocardiography clearly demonstrated the intraluminal mass by means of its different color hues as compared with the surrounding vessel wall, further enforcing the suspicion of upper extremity vein thrombosis (UEVT). It is emphasized that tissue Doppler echocardiography, a safe and reproducible method, can contribute to the diagnosis of UEVT.     

Not that atretic: Use of an atretic femoral vein for transcatheter pulmonary valve implantation

We report a case of a child with congenital heart disease who presented with critical right ventricular outflow tract obstruction and a history of bilateral femoral vein occlusion. He underwent successful right ventricular outflow tract intervention, culminating in transcatheter pulmonary valve implantation, after recanalization of a completely obstructed femoral vein. © 2016 Wiley Periodicals, Inc.     

Conduction tissue anomalies in absence of the right superior caval vein

The incidence of electrical instability of the heart is high in patients with absence of the right and persistence of the left superior caval vein when the latter connects to the coronary sinus. It has been suggested that a large coronary sinus may influence the susceptibility to arrhythmias. we studied the conduction tissues of 8 hearts from the cardiopathological collection of Children's Hospital of Pittsburgh. Six of these specimens had a persistent left superior caval vein connecting to the coronary sinus. There were 4 with absence of the right superior caval vein, 3 of which were in the group with persistent left veins. We evaluated the sinus node and the specialized atrioventricular junctional area, comparing them with known normals. The coronary sinus varied in size from through it. The size did not alter the histology of the adjacent conduction tissue. In contrast, the sinus node was abnormal in 3 of the 4 hearts with absent right superior caval vein. This may be the key factor in the development of arrhythmias when the right superior caval vein is absent or abnormal.