Transatrial membranotomy for Budd-Chiari syndrome.
In a 7-year period, transatrial membranotomy was performed in 11 patients with membranous obstruction of the inferior vena cava. There were 5 men and 6 women, ranging in age from 23 to 53 years. Clinical symptoms included jaundice in 4 patients, hepatomegaly in 4, leg edema or varicose veins in 10, and venous collaterals over the abdominal and chest wall in all 11 patients. Transatrial membranotomy was performed through a median sternotomy in all patients. When inferior vena cava venography revealed that the obstruction was accompanied by long segmental thrombosis, additional dilation was performed with a Hegar dilator. There was no surgical mortality. Early operative complications included pulmonary embolism in 2 patients and bleeding requiring reoperation in 1. In a mean follow-up period of 30.6 months (range, 2 to 88 months), 9 patients had no symptoms, transient pericardial constriction developed in 1 patient and resolved 1 month later, and restenosis of the inferior vena cava developed in another patient 1 year after the first operation. This latter patient received a second transatrial membranotomy followed by percutaneous balloon angioplasty of the inferior vena cava, with a satisfactory result at 8 months follow-up. We conclude that transatrial membranotomy is an effective and safe procedure for patients with membranous obstruction of the inferior vena cava.
Chang
C H
CH
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Lee
M C
MC
Shieh
M J
MJ
Chang
J P
JP
Lin
P J
PJ
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D014652:Vascular Diseases / Q000150:complications / Q000000981:diagnostic imaging; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*