Membranous Obstruction of the Inferior Vena Cava and Hepatic Veins

Three cases of membranous obstruction of the inferior vena cava (IVC) are presented. Two of them underwent transcardiac membranotomy with good results. The third patient was treated symptomatically and died from gastrointestinal hemorrhage and hepatic coma two years after the diagnosis of Budd-Chiari syndrome. At autopsy, membranes were found in the inferior vena cava and hepatic veins. Differentiation of Budd-Chiari syndrome secondary to the presence of such a membrane is essential since these patients are potentially curable by surgical treatment. Cavography visualizes the obstruction and is the procedure of choice for diagnosis of this condition. Surgical treatment with transcardiac membranotomy is effective. Some hepatic abnormalities regress after surgery. Prophylactic postoperative treatment with diuretics seems advisable in these patients to prevent congestive cardiac failure.