Meso-portal bypass in children with portal vein thrombosis: rapid increase of the intrahepatic portal venous flow after direct portal hepatic reperfusion.
OBJECTIVE
In children with portal vein (PV) thrombosis, hepatopetal portal flow can be restored by an innovative surgical procedure, the meso-portal-bypass (MPB), if the umbilical portion of the intrahepatic left PV and the superior mesenteric vein are patent. This is associated with resolution of symptoms related to extrahepatic portal hypertension (EHPH). However, no data are available yet on intrahepatic hemodynamic changes after MPB. The aim of this study was to evaluate morphologic adaptation and flow characteristics of the intrahepatic PV branches (ihPVb) after MPB.


METHODS
Prospective follow-up Doppler scans of the ihPVb were performed at 0.5 to 1, 3 to 6 and 12 months after MPB in 13 consecutive patients (2000-2002) and compared with preoperative findings.


RESULTS
Only small ihPVb were detected preoperatively on Doppler in 8 of 13 cases. Postoperatively (median follow up 12; range, 6 to 24 months), all 13 patients had patent MPB with hepatopetal flow, and ihPVb were easy to detect with satisfactory vessel diameters and flow velocities.


CONCLUSIONS
The preoperatively small ihPVb increase rapidly in diameter and hepatopetal flow velocity in patients benefiting from MPB. This correlates well with progressive resolution of their symptoms related to EHPH and reflects rapid adaptation of ihPVb.
Gehrke
I
I
Liver Unit, Birmingham Children Hospital, Birmingham, England UK.
John
P
P
Blundell
J
J
Pearson
L
L
Williams
A
A
de Ville de Goyet
J
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D007223:Infant; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery*; D011168:Portal System / Q000000981:diagnostic imaging; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D011170:Portasystemic Shunt, Surgical; D011446:Prospective Studies; D013927:Thrombosis / Q000150:complications*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler