title: Variations in anatomy of the middle hepatic vein and their impact on formal right hepatectomy.
abstract: BACKGROUND
  We evaluated the incidence of variations of the middle hepatic vein (MHV) branches and their impact on formal right hepatectomy for living-donor liver transplantation.
  
  
  METHODS
  Fifty consecutive patients who underwent hepatic multidetector row computed tomography (CT) were evaluated. Three-dimensional volume rendering techniques were used to evaluate the different branching patterns of the MHV. An incision plane was constructed to simulate a formal hepatectomy along Cantlie's line, immediately to the right of the MHV. The number of transected vessels was recorded by consensus of two observers.
  
  
  RESULTS
  In 11 patients (22%) the MHV had no major (>5 mm) branches. In 15 patients (30%) a major branch was seen draining the right lobe, and in 10 patients (20%) a major branch was seen draining each lobe. In five patients (10%) two major branches were seen draining the right lobe and a single branch draining the left lobe. The remaining nine patients (18%) had other variations, including one patient (2%) with the right hepatic vein arising from the MHV. A formal hepatectomy along Cantlie's line was truly avascular in 15 patients (30%).
  
  
  CONCLUSIONS
  A formal right hepatectomy can be performed without transecting major branches of the MHV in one-third of patients. In the remaining two-thirds, one or more major branch of the MHV will need be transected. Preoperative knowledge of these variations is critical for surgical planning.
authors: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, USA.
authors: I R
authors: IR
authors: Kamel
authors: L P
authors: LP
authors: Lawler
authors: E K
authors: EK
authors: Fishman
mesh_terms: D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed