title: Accessory hepatic vein complicating extra-cardiac total cavopulmonary connection.
abstract: We encountered unexpected, severe hypoxia after the right heart bypass operation in a patient with isomerism. A 2-year-old girl with polysplenia had a complex cardiac anomaly consisting of a single atrium, single ventricle, pulmonary stenosis, absence of the right superior vena cava, hemiazygos continuation of the left inferior vena cava, and d-malposition of the great arteries. After a total cavopulmonary shunt, we performed an extra-cardiac total cavo-pulmonary connection with a 14 mm tube graft. The postoperative course was complicated by severe hypoxia. Angiography performed 20 days after the operation showed that contrast medium in the conduit poured into the hepatic vein, and through the intrahepatic communications, it passed into a left-sided accessory hepatic vein, which was connected directly to the left side of the aspect of the atrium. As the intrahepatic communication was adequate, we ligated the accessory hepatic vein within the pericardial cavity. The SpO2 returned to normal and no hepatic dysfunction was detected. We conclude that surgeons performing extra-cardiac total cavopulmonary connection need to pay closer attention to the possibility that an accessory hepatic vein might exist.
authors.affiliation: Department of Surgery, Yamanashi Medical University, Tamaho-cho, Nakakoma-gun, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Yoshii
authors.forename: Shoji
authors.initials: S
authors.lastname: Suzuki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Osawa
authors.forename: Shigeru
authors.initials: S
authors.lastname: Hosaka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Honda
authors.forename: Samuel J K
authors.initials: SJ
authors.lastname: Abraham
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tada
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Tan
authors.forename: Toshie
authors.initials: T
authors.lastname: Kadono
authors.forename: Minako
authors.initials: M
authors.lastname: Hoshiai
authors.forename: Takayuki
authors.initials: T
authors.lastname: Komai
mesh_terms: D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery; D006503:Hepatic Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007536:Isomerism; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography