TIPSS Procedure in the Treatment of a Single Patient After Recent Heart Transplantation Because of Refractory Ascites Due to Cardiac Cirrhosis

  • Mario Fava
  • Luis Meneses
  • Soledad Loyola
  • Pablo Castro
  • Fernando Barahona
Case Report


We present the case of a female patient with arrhythmogenic dysplasia of the right ventricle who evolved to refractory heart failure, ascites, and peripheral edema. As a result, heart transplantation was performed. Subsequently, refractory ascites impaired the patient’s respiratory function, resulting in prolonged mechanical ventilation. She was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement, which allowed satisfactory weaning of ventilatory support.


Hepatic cirrhosis TIPSS Ascites 


  1. 1.
    Rössle M, Ochs A, Veit Gülberg V et al. (2000) A comparison of paracentesis and transjugular intrahepatic portosystemic shunting in patients with ascites. N Engl J Med 342(23):1701–1707PubMedCrossRefGoogle Scholar
  2. 2.
    Ochs A, Rössle M, Haag K et al. (1995) The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites. N Engl J Med 332(18):1192–1197PubMedCrossRefGoogle Scholar
  3. 3.
    Yoon CJ, Chung JW, Park JH (2005) Transjugular intrahepatic portosystemic shunt for acute variceal bleeding in patients with viral liver cirrhosis: predictors of early mortality. AJR 185(4):885–889PubMedCrossRefGoogle Scholar
  4. 4.
    Vignali C, Bargellini T, Grosso M et al. (2005) TIPS with expanded polytetrafluoroethylene-covered stent: results of an Italian multicenter. AJR 185(2):472–480PubMedGoogle Scholar
  5. 5.
    Cello JP, Ring EJ, Olcott EW et al. (1997) Endoscopic sclerotherapy compared with percutaneous transjugular intrahepatic portosystemic shunt after initial sclerotherapy in patients with acute variceal hemorrhage. A randomized, controlled trial. Ann Intern Med 126(11):858–865Google Scholar
  6. 6.
    D Amico G, Luca A, Morabito A et al. (2005) Uncovered transjugular intrahepatic portosystemic shunt for refractory ascites: a meta-analysis. Gastroenterology 129(4):1282–1293CrossRefGoogle Scholar
  7. 7.
    Saab S, Nieto JM, Runyon BA (2004) TIPS versus paracentesis for cirrhotic patients with refractory ascites. Cochrane Database Syst Rev 3:CD004889PubMedGoogle Scholar
  8. 8.
    Russo MW, Sood A, Jacobson IM et al. (2003) Transjugular intrahepatic portosystemic shunt for refractory ascites: an analysis of the literature on efficacy, morbidity, and mortality. Am J Gatroenterol 98(11):2521–2527CrossRefGoogle Scholar
  9. 9.
    Rosemurgy AS, Zervos EE, Clark WC et al. (2004) TIPS versus peritoneovenous shunt in the treatment of medically intractable ascites: a prospective randomized trial. Ann Surg 239(6):883–889PubMedCrossRefGoogle Scholar
  10. 10.
    Kuradusenge P, Rousseau H, Vinel JP et al. (1993) Traitement des hémorragies par rupture de varices cardio-tubérositaires par anastomose porto-systémique intra-hépatique par voie transjugulaire. Gastroenterol Clin Biol 17:431–434PubMedGoogle Scholar
  11. 11.
    Rousseau H, Vinel JP, Bilbao J et al. (1994) Transjugular intrahepatic portosystemic shunt using the Wallstent prosthesis: a follow-up study. CardioVasc Interv Radiol 17(1):7–11CrossRefGoogle Scholar
  12. 12.
    Naschitz J, Slobodin G, Lewis R et al. (2000) Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J 140(1):111–120PubMedCrossRefGoogle Scholar
  13. 13.
    Wanless IR, Liu JJ, Butany J (1995) Role of thrombosis in the pathogenesis of CLF (cardiac cirrhosis). Hepatology 21(5):1232–1237PubMedGoogle Scholar
  14. 14.
    Chan M, Giannetti N, Kato T et al. (2001) Tricuspid regurgitation after heart transplantation. J Heart Lung Transplant 20(7):709–717PubMedCrossRefGoogle Scholar
  15. 15.
    Schwartz JM, Beymer C, Althaus SJ et al. (2004) Cardiopulmonary consequences of transjugular intrahepatic portosystemic shunts: role of increased pulmonary artery pressure. J Clin Gastroenterol 38(7):590–594PubMedCrossRefGoogle Scholar
  16. 16.
    Lotterer E, Wengert A, Fleig WE (1999) Transjugular intrahepatic portosystemic shunt: short term and long term effects on hepatic and systemic hemodynamics in patients with cirrhosis. Hepatology 29(3):632–639PubMedCrossRefGoogle Scholar
  17. 17.
    Huonker M, Schumacher YO, Ochs A et al. (1999) Cardiac function and haemodynamics in alcoholic cirrhosis and effects of the transjugular intrahepatic portosystemic stent shunt. Gut 44(5):743–748PubMedCrossRefGoogle Scholar
  18. 18.
    Givertz M, Hartley L, Colucci W (1997) Long-term Sequential changes in exercise capacity and chronotropic responsiveness after cardiac transplantation. Circulation 96(1):232–237PubMedGoogle Scholar
  19. 19.
    Lee S, Liu H (2007) Cardiovascular determinants of survival in cirrhosis. Gut 56(6):746–748PubMedCrossRefGoogle Scholar
  20. 20.
    Cazzaniga M, Salerno F, Pagnozzi G et al. (2007) Diastolic dysfunction is associated with poor survival in patients with cirrhosis with transjugular intrahepatic portosystemic shunt. Gut 56(6):869–875PubMedCrossRefGoogle Scholar
  21. 21.
    Sade L, Sezgin A, Ulucam L et al. (2006) Evaluation of the potential role of echocardiography in the detection of allograft rejection in heart transplant recipients. Transpl Proc 38(2):636–638CrossRefGoogle Scholar
  22. 22.
    Nair S, Singh R, Yoselewitz M (2004) Correlation between portal/hepatic vein gradient and response to transjugular intrahepatic portosystemic shunt creation in refractory ascites. J Vasc Interv Radiol 15(12):1431–1434PubMedGoogle Scholar
  23. 23.
    Harrod-Kim P, Saad W, Waldman D (2006) Predictors of early mortality after transjugular intrahepatic portosystemic shunt creation for the treatment of refractory ascites. J Vasc Interv Radiol 17(10):1605–1610PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Mario Fava
    • 1
  • Luis Meneses
    • 1
  • Soledad Loyola
    • 1
  • Pablo Castro
    • 2
  • Fernando Barahona
    • 2
  1. 1.Radiology DepartmentHospital Clínico Universidad Católica de ChileSantiagoChile
  2. 2.Cardiology DepartmentHospital Clínico Universidad Católica de ChileSantiagoChile

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