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MESO‐ATRIAL SHUNT IN THE SURGICAL TREATMENT OF BUDD‐CHIARI SYNDROME
Author(s) -
Khanduri Prakash,
Nathaniel Philip,
Jesudason S. B.,
Lal Navin P,
Krishnaswamy S.,
Sudersanam Doss
Publication year - 1983
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1983.tb02453.x
Subject(s) - medicine , budd–chiari syndrome , ascites , shunt (medical) , inferior vena cava , asymptomatic , surgery , occlusion , lumen (anatomy) , angiography , stenosis , radiology
Three patients with idiopathic Budd‐Chiari syndrome with occlusion of the hepatic veins and significant obstruction of the hepatic segment of the inferior vena cava are presented. The inferior vena caval obstruction precluded the use of conventional side‐to‐side portacaval or mesocaval shunts. Dramatic regression in liver size and resolution of ascites occurred in all three patients following the construction of meso‐atrial shunts using wide‐lumen woven Dacron grafts. Shunt patency was confirmed by angiography in two patients and Doppler studies in one. One patient died five months after surgery and another after 16 months. The shunts were widely patent at autopsy and the full length of the grafts were lined by neo‐intima. The third patient is asymptomatic 20 months after surgery and is free of ascites. Our experience in these three cases suggests that patency can be expected in long synthetic grafts between the portal and systemic venous system provided the shunt is of adequate diameter and there is a pressure gradient between the two ends.