Transjugular intrahepatic portosystemic shunt prior to cardiac surgery with cardiopulmonary bypass in patients with cirrhosis and portal hypertension.
Because of the increased complications associated with cardiac surgery in patients with cirrhosis and portal hypertension, various preoperative preparations have been utilised. In order to reduce the bleeding risk by decompressing portosystemic collaterals and to correct the fluid shift, we performed transjugular intrahepatic portosystemic shunt (TIPS) in two patients with cirrhosis and portal hypertension prior to major cardiac surgery with cardiopulmonary bypass. Both patients had satisfactory surgical outcome with no bleeding complications. One patient developed hepatic encephalopathy which was managed medically. We believe that preoperative TIPS benefits the patient with cirrhosis and portal hypertension undergoing cardiac surgery by decreasing the major surgical complications through improvement of fluid imbalance and reduction of the bleeding risk. Because of the risks of TIPS, such as encephalopathy and liver failure, preoperative TIPS placement must be reserved for patients with fluid shift or high risk criteria of bleeding.
Semiz-Oysu
Aslihan
A
University of Michigan Hospital, Department of Radiology, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0030, USA. aslihans@med.umich.edu
Moustafa
Tarek
T
Cho
Kyung J
KJ
D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D002305:Cardiac Tamponade / Q000188:drug therapy / Q000209:etiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D005765:Gastrointestinal Agents / Q000494:pharmacology; D006501:Hepatic Encephalopathy / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007792:Lactulose / Q000494:pharmacology; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000517:prevention & control*
D005765:Gastrointestinal Agents; D007792:Lactulose