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Management of portopulmonary hypertension:New perspectives

World Journal of Gastroenterology 2013年第45期19卷 8252-8257页

作者： luigi mancuso Francesca Scordato Michela Pieri Eliana Valerio Andrea mancuso Department of Cardiologia Ospedale Cervello90100 Palermo Italy Cardiologia Clinica Candela 90100 Palermo Italy Epatologia e Gastroenterologia Ospedale Niguarda Cà Granda Milano 20162 Milano Italy Medicina Interna 1 ARNAS Civico 90100 Palermo Italy

Portopulmonary hypertension(PPHTN)is a known complication of ***-to-severe PPHTN implies an extremely poor *** occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic *** with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was ***,new perspectives in the management of patients with portopulmonary hypertension are *** fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary *** drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular ***,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent *** there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.

关键词： Portopulmonary hypertension Cirrhosis Liver transplantation Management Epoprostenol

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A caval homograft for Budd-Chiari syndrome due to inferior vena cava obstruction

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World Journal of Hepatology 2013年第5期5卷 292-295页

作者： Andrea mancuso luigi Martinelli Luciano De Carlis Antonio Gaetano Rampoldi Giovanni Magenta Aldo Cannata Luca Saverio Belli Epatologia e Gastroenterologia Ospedale Niguarda Cà GrandaPiazza Ospedale Maggiore 320162 MilanoItaly Cardiochirurgia Ospedale Niguarda Cà GrandaPiazza Ospedale Maggiore 320162 MilanoItaly Chirurgia Generale e dei Trapianti Ospedale Niguarda Cà GrandaPiazza Ospedale Maggiore 320162 MilanoItaly Radiologia Interventistica Ospedale Niguarda Cà GrandaPiazza Ospedale Maggiore 320162 MilanoItaly Cardiologia 3 Ospedale Niguarda Cà GrandaPiazza Ospedale Maggiore 320162 MilanoItaly

Transjugular intrahepatic portosystemic shunt (TIPS) is the standard treatment of Budd-Chiari syndrome (BCS) non responsive to medical therapy. However, patients with inferior vena cava (IVC) obstruction proximal to the atrium do not benefit from TIPS and a surgical approach is mandatory. We report the case of BCS due to intrapericardial IVC obstruction. We describe a novel surgical approach using a fresh caval homograft. An attempt to balloon dilatation of the IVC obstruction was complicated by right atrial disruption with tamponade and ventricular fibrillation. Lately, the patient successfully underwent a reconstruction of the cavo-atrial continuity by the interposition of a fresh caval homograft, a novel surgical approach never described before for BCS. Further follow-up revealed progressive reduction and resolution of ascites, and overall clinical improvement. IVC obstruction near to the atrium can be surgically approached with a new technique consisting in inferior vena cava resection and replacement with a caval homograft.

关键词： Budd-Chiari syndrome Inferior vena cava Occlusion Surgery Liver transplantation

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