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CardioVascular and Interventional Radiology

, Volume 36, Issue 6, pp 1580–1585 | Cite as

Staged Transcatheter Treatment of Portal Hypoplasia and Congenital Portosystemic Shunts in Children

  • Elchanan BruckheimerEmail author
  • Tamir Dagan
  • Eli Atar
  • Michael Schwartz
  • Ludmila Kachko
  • Riccardo Superina
  • Gabriel Amir
  • Rivka Shapiro
  • Einat Birk
Clinical Investigation

Abstract

Purpose

Congenital portosystemic shunts (CPSS) with portal venous hypoplasia cause hyperammonemia. Acute shunt closure results in portal hypertension. A transcatheter method of staged shunt reduction to afford growth of portal vessels followed by shunt closure is reported.

Methods

Pressure measurements and angiography in the CPSS or superior mesenteric artery (SMA) during temporary occlusion of the shunt were performed. If vessels were diminutive and the pressure was above 18 mmHg, a staged approach was performed, which included implantation of a tailored reducing stent to reduce shunt diameter by ~50 %. Recatheterization was performed approximately 3 months later. If the portal pressure was below 18 mmHg and vessels had developed, the shunt was closed with a device.

Results

Six patients (5 boys, 1 girl) with a median age of 3.3 (range 0.5–13) years had CPSS portal venous hypoplasia and hyperammonemia. Five patients underwent staged closure. One patient tolerated acute closure. One patient required surgical shunt banding because a reducing stent could not be positioned. At median follow-up of 3.8 (range 2.2–8.4) years, a total of 21 procedures (20 transcatheter, 1 surgical) were performed. In all patients, the shunt was closed with a significant reduction in portal pressure (27.7 ± 11.3 to 10.8 ± 1.8 mmHg; p = 0.016), significant growth of the portal vessels (0.8 ± 0.5 to 4.0 ± 2.4 mm; p = 0.037), and normalization of ammonia levels (202.1 ± 53.6 to 65.7 ± 9.6 μmol/L; p = 0.002) with no complications.

Conclusion

Staged CPSS closure is effective in causing portal vessel growth and treating hyperammonemia.

Keywords

Abernethy Portal hypoplasia Portosystemic shunt Reducing stent 

Notes

Conflict of interest

Bruckheimer is a paid consultant for Atrium Medical Corp., Hudson, NH. The other authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Elchanan Bruckheimer
    • 1
    Email author
  • Tamir Dagan
    • 1
  • Eli Atar
    • 2
  • Michael Schwartz
    • 2
  • Ludmila Kachko
    • 3
  • Riccardo Superina
    • 1
  • Gabriel Amir
    • 1
  • Rivka Shapiro
    • 4
  • Einat Birk
    • 1
  1. 1.Section of Pediatric CardiologySchneider Children’s Medical Center IsraelPetach TikvaIsrael
  2. 2.Section of RadiologySchneider Children’s Medical Center IsraelPetach TikvaIsrael
  3. 3.Section of AnesthesiologySchneider Children’s Medical Center IsraelPetach TikvaIsrael
  4. 4.Section of GastroenterologySchneider Children’s Medical Center IsraelPetach TikvaIsrael

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