Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation...

Autores
Rubio, Juan S.; Rumbo, Carolina; Farinelli, Pablo A.; Aguirre, Nicolás; Ramisch, Diego A.; Paladini, Hugo; D´Angelo, Pablo; Barros Schelotto, Pablo; Gondolesi, Gabriel Eduardo
Año de publicación
2018
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation.
Fil: Rubio, Juan S.. Fundación Favaloro; Argentina
Fil: Rumbo, Carolina. Fundación Favaloro; Argentina
Fil: Farinelli, Pablo A.. Fundación Favaloro; Argentina
Fil: Aguirre, Nicolás. Fundación Favaloro; Argentina
Fil: Ramisch, Diego A.. Fundación Favaloro; Argentina
Fil: Paladini, Hugo. Fundación Favaloro; Argentina
Fil: D´Angelo, Pablo. Fundación Favaloro; Argentina
Fil: Barros Schelotto, Pablo. Fundación Favaloro; Argentina
Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina
Materia
LIVING DONOR LIVER TRANSPLANTATION
PORTAL THROMBOSIS
PORTO-SYSTEMIC SHUNT
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/87736
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/87736
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case reportRubio, Juan S.Rumbo, CarolinaFarinelli, Pablo A.Aguirre, NicolásRamisch, Diego A.Paladini, HugoD´Angelo, PabloBarros Schelotto, PabloGondolesi, Gabriel EduardoLIVING DONOR LIVER TRANSPLANTATIONPORTAL THROMBOSISPORTO-SYSTEMIC SHUNThttps://purl.org/becyt/ford/3.2https://purl.org/becyt/ford/3Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation.Fil: Rubio, Juan S.. Fundación Favaloro; ArgentinaFil: Rumbo, Carolina. Fundación Favaloro; ArgentinaFil: Farinelli, Pablo A.. Fundación Favaloro; ArgentinaFil: Aguirre, Nicolás. Fundación Favaloro; ArgentinaFil: Ramisch, Diego A.. Fundación Favaloro; ArgentinaFil: Paladini, Hugo. Fundación Favaloro; ArgentinaFil: D´Angelo, Pablo. Fundación Favaloro; ArgentinaFil: Barros Schelotto, Pablo. Fundación Favaloro; ArgentinaFil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; ArgentinaWiley Blackwell Publishing, Inc2018-03info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/87736Rubio, Juan S.; Rumbo, Carolina; Farinelli, Pablo A.; Aguirre, Nicolás; Ramisch, Diego A.; et al.; Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report; Wiley Blackwell Publishing, Inc; Pediatric Transplantation; 22; 2; 3-2018; 1-41397-3142CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.1111/petr.13111info:eu-repo/semantics/altIdentifier/url/https://onlinelibrary.wiley.com/doi/abs/10.1111/petr.13111info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-03T09:48:15Zoai:ri.conicet.gov.ar:11336/87736instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-03 09:48:15.615CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
title Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
spellingShingle Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
Rubio, Juan S.
LIVING DONOR LIVER TRANSPLANTATION
PORTAL THROMBOSIS
PORTO-SYSTEMIC SHUNT
title_short Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
title_full Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
title_fullStr Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
title_full_unstemmed Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
title_sort Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report
dc.creator.none.fl_str_mv Rubio, Juan S.
Rumbo, Carolina
Farinelli, Pablo A.
Aguirre, Nicolás
Ramisch, Diego A.
Paladini, Hugo
D´Angelo, Pablo
Barros Schelotto, Pablo
Gondolesi, Gabriel Eduardo
author Rubio, Juan S.
author_facet Rubio, Juan S.
Rumbo, Carolina
Farinelli, Pablo A.
Aguirre, Nicolás
Ramisch, Diego A.
Paladini, Hugo
D´Angelo, Pablo
Barros Schelotto, Pablo
Gondolesi, Gabriel Eduardo
author_role author
author2 Rumbo, Carolina
Farinelli, Pablo A.
Aguirre, Nicolás
Ramisch, Diego A.
Paladini, Hugo
D´Angelo, Pablo
Barros Schelotto, Pablo
Gondolesi, Gabriel Eduardo
author2_role author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv LIVING DONOR LIVER TRANSPLANTATION
PORTAL THROMBOSIS
PORTO-SYSTEMIC SHUNT
topic LIVING DONOR LIVER TRANSPLANTATION
PORTAL THROMBOSIS
PORTO-SYSTEMIC SHUNT
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.2
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation.
Fil: Rubio, Juan S.. Fundación Favaloro; Argentina
Fil: Rumbo, Carolina. Fundación Favaloro; Argentina
Fil: Farinelli, Pablo A.. Fundación Favaloro; Argentina
Fil: Aguirre, Nicolás. Fundación Favaloro; Argentina
Fil: Ramisch, Diego A.. Fundación Favaloro; Argentina
Fil: Paladini, Hugo. Fundación Favaloro; Argentina
Fil: D´Angelo, Pablo. Fundación Favaloro; Argentina
Fil: Barros Schelotto, Pablo. Fundación Favaloro; Argentina
Fil: Gondolesi, Gabriel Eduardo. Fundación Favaloro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional, Trasplante y Bioingeniería. Fundación Favaloro. Instituto de Medicina Traslacional, Trasplante y Bioingeniería; Argentina
description Collateral circulation secondary to liver cirrhosis may cause the development of large PSSs that may steal flow from the main portal circulation. It is important to identify these shunts prior to, or during the transplant surgery because they might cause an insufficient portal flow to the implanted graft. There are few reports of “steal flow syndrome” cases in pediatrics, even in biliary atresia patients that may have portal hypoplasia as an associated malformation. We present a 12-month-old female who received an uneventful LDLT from her mother, and the GRWR was 4.8. During the early post-operative period, she became hemodynamically unstable, developed ascites, and altered LFT. The post-operative ultrasound identified reversed portal flow, finding a non-anatomical PSS. A 3D CT scan confirmed the presence of a mesocaval shunt through the territory of the right gonadal vein, draining into the right iliac vein, with no portal inflow into the liver. The patient was re-operated, and the shunt was ligated. An intraoperative Doppler ultrasound showed adequate portal inflow after the procedure; the patient evolved satisfactorily and was discharged home on day number 49. The aim was to report a case of post-operative steal syndrome in a pediatric recipient due to a mesocaval shunt not diagnosed during the pretransplant evaluation.
publishDate 2018
dc.date.none.fl_str_mv 2018-03
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/87736
Rubio, Juan S.; Rumbo, Carolina; Farinelli, Pablo A.; Aguirre, Nicolás; Ramisch, Diego A.; et al.; Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report; Wiley Blackwell Publishing, Inc; Pediatric Transplantation; 22; 2; 3-2018; 1-4
1397-3142
CONICET Digital
CONICET
url http://hdl.handle.net/11336/87736
identifier_str_mv Rubio, Juan S.; Rumbo, Carolina; Farinelli, Pablo A.; Aguirre, Nicolás; Ramisch, Diego A.; et al.; Unusual spontaneous porto-systemic shunt: The importance of diagnosing non-anatomical porto-systemic shunts to improve portal flow in pediatric living–related liver transplantation. Case report; Wiley Blackwell Publishing, Inc; Pediatric Transplantation; 22; 2; 3-2018; 1-4
1397-3142
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.1111/petr.13111
info:eu-repo/semantics/altIdentifier/url/https://onlinelibrary.wiley.com/doi/abs/10.1111/petr.13111
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wiley Blackwell Publishing, Inc
publisher.none.fl_str_mv Wiley Blackwell Publishing, Inc
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
_version_ 1842268913169072128
score 13.13397

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