Autori:
Vladislav Braşoveanu1,2, Emil Matei1, Mihnea Ioan Ionescu1, Bogdan Rădulescu3, Speranţa Iacob4, Nicolae Bacalbaşa1, Mugur Grasu5, Radu Dumitru5, Dana Tomescu6, Irinel Popescu1
1“Dan Setlacec” Center of General Surgery and Liver Transplantation Fundeni Clinical Institute, Bucharest, Romania
2Faculty of Medicine, “Titu Maiorescu” University, Bucharest, Romania
3“CC Iliescu” Emergency Center of Cardiovascular Diseases, Bucharest, Romania
4Clinic of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
5Center of Imagistics and Interventional Radiology, Fundeni Clinical Institute, Bucharest, Romania
6Center of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
2Faculty of Medicine, “Titu Maiorescu” University, Bucharest, Romania
3“CC Iliescu” Emergency Center of Cardiovascular Diseases, Bucharest, Romania
4Clinic of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania
5Center of Imagistics and Interventional Radiology, Fundeni Clinical Institute, Bucharest, Romania
6Center of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
Rezumat:
Introduction: Budd-Chiari syndrome associated with inferior vena cava (IVC) thrombosis extended to the right atrium is a rare condition, which requires liver transplantation with different techniques of caval reconstruction. The procedure is technically demanding, especially if it is performed solely transdiaphragmatically.
Case presentation: An orthotopic liver transplantation (OLT) was performed in April 2014 in a 24-year old male patient with Budd-Chiari syndrome due to idiopathic thrombophilia and complete thrombosis of the retrohepatic IVC, up to its intrapericardic portion. Due to the impossibility of performing a cavo-caval anastomosis, a transdiaphragmatic anastomosis between the recipient right atrium and the donor superior cuff of the IVC was performed, without sternotomy.
Results: Postoperative course was uneventful except for persitent ascites, which was successfully managed with diuretics. The patient was discharged after 34 days; 9 months postoperatively he has optimal liver function and has returned to normal life Conclusion: A transdiaphragmatic cavo-atrial anastomosis represents a feasible option in the setting of OLT, when the recipient IVC cannot be used due to extensive thrombosis, especially if it is performed by a multidisciplinary operative team.
Key words: orthotopic liver transplantation, transdiaphragmatic
Case presentation: An orthotopic liver transplantation (OLT) was performed in April 2014 in a 24-year old male patient with Budd-Chiari syndrome due to idiopathic thrombophilia and complete thrombosis of the retrohepatic IVC, up to its intrapericardic portion. Due to the impossibility of performing a cavo-caval anastomosis, a transdiaphragmatic anastomosis between the recipient right atrium and the donor superior cuff of the IVC was performed, without sternotomy.
Results: Postoperative course was uneventful except for persitent ascites, which was successfully managed with diuretics. The patient was discharged after 34 days; 9 months postoperatively he has optimal liver function and has returned to normal life Conclusion: A transdiaphragmatic cavo-atrial anastomosis represents a feasible option in the setting of OLT, when the recipient IVC cannot be used due to extensive thrombosis, especially if it is performed by a multidisciplinary operative team.
Key words: orthotopic liver transplantation, transdiaphragmatic
Publicat:
J. Transl. Med. Res 2015;1(20):26-31
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