Endovascular Treatment of Congenital Portosystemic Shunt: A Single-Center Prospective Study

Long-term follow-up and transcatheter embolization of extrahepatic congenital portosystemic shunt with shifting hemodynamics

Congenital portosystemic shunt (CPSS) is a rare vascular anomaly in which portal vein blood flows into the systemic circulation without passing through the liver. They occur in approximately 1 in 30,000-50,000 live births. We present an 11-year-old patient with an extrahepatic CPSS managed with long-term follow-up. The initial clinical presentation showed no significant abnormalities. Subsequent assessments revealed slightly elevated ammonia (NH3) and total bile acids (TBAs). Two times angiography at the ages of 2 and 11 years confirmed a shunt between the portal vein and left renal vein, with a gradual shift in blood flow dominance from the celiac artery-splenic vein system to the superior mesenteric artery-superior mesenteric vein system as the patient aged. Due to the risk of complications, transcatheter shunt embolization was performed, utilizing 12 coils to achieve complete shunt embolization. Post-embolization, NH3, and TBA levels normalized, and the patient remained asymptomatic. This case highlights the importance of timing in CPSS intervention, particularly with shifting hemodynamics and underscores the need for further studies on optimal intervention timing in pediatric CPSS.

Novel Staged Device Occlusion of Portosystemic Shunt With Atrial Flow Regulator in IVC Stent Platform

We present the cases of 2 children diagnosed with extrahepatic portosystemic shunts, a very rare vascular anomaly, on investigation of cardiac symptomatology. Poorly developed portal venous systems necessitated staged shunt occlusion. This was achieved using atrial flow regulator devices positioned in an inferior vena cava stent platform performed in the cardiac catheterization laboratory.

Expert management of congenital portosystemic shunts and their complications

Congenital portosystemic shunts are often associated with systemic complications, the most challenging of which are liver nodules, pulmonary hypertension, endocrine abnormalities, and neurocognitive dysfunction. In the present paper, we offer expert clinical guidance on the management of liver nodules, pulmonary hypertension, and endocrine abnormalities, and we make recommendations regarding shunt closure and follow-up.

Prenatal ultrasonographic features and follow-up outcomes of 19 cases of congenital intrahepatic portosystemic venous shunts diagnosed during the foetal period

Background

To investigate the prenatal ultrasonographic features and case characteristics of the congenital intrahepatic portosystemic venous shunt (IHPSS) diagnosed during the foetal period and analyse its prognosis.

Methods

We conducted a retrospective cohort study of patients diagnosed with IHPSS between 2016 and 2021. IHPSS was defined as an abnormal connection between the foetal intrahepatic portal and the hepatic veins.

Results

In this study, 19 foetuses were identified, including 12 cases of single shunt and 7 cases of multiple shunts, with a gestational age of 33.8 ± 4.5 (range 25–40) weeks at diagnosis. In the single-shunt group, the origin position of the shunts was all from the left branch of the portal vein (LPV), whereas in the multiple-shunt group, the origin position of the shunts was from the LPV in six cases. Common concomitant intrauterine abnormalities of IHPSS include foetal growth restriction (47.4%) and foetal cardiac enlargement (21.1%). The postnatal manifestations of IHPSS include biochemical abnormalities (increased gamma-glutamyl transferase and bilirubin levels), neonatal hypoglycaemia, neonatal hyperammonaemia, pulmonary hypertension, multiple intrahepatic hyperechoic nodules, and cutaneous haemangiomas. Spontaneous closure of shunts occurred in ten cases, and the mean time to shunt closure was 8.1 months (1–28 months).

Conclusions

Most IHPSS found during the foetal period is located in the left branch of the portal vein, and the gestational age at diagnosis is usually in the late second or third trimester. Spontaneous closure of shunts can occur in most live births, and the prognosis is good.