title: Congenital extrahepatic portosystemic shunt associated with heterotaxy and polysplenia.
abstract: BACKGROUND
  Heterotaxy with polysplenia is associated with many cardiovascular anomalies including the occasional occurrence of congenital extrahepatic portosystemic shunts (CEPS). Missing this anomaly can lead to inappropriate and ineffective therapy.
  
  
  OBJECTIVE
  To emphasize the importance and associated anatomy of CEPS in conjunction with heterotaxy with polysplenia.
  
  
  METHODS
  Review of three young children who presented with cyanosis and pulmonary hypertension without a cardiac etiology. They were known (1) or discovered (2) to have heterotaxy with polysplenia.
  
  
  RESULTS
  There was absence of the intrahepatic inferior vena cava (IVC) with azygos or hemiazygos continuation in all three cases. In spite of normal liver function, they were discovered to have large portosystemic shunts, splenorenal in location, along with diffuse peripheral pulmonary arterial dilatation suggestive of CEPS (Abernethy malformation) with hepatopulmonary or, more accurately, portopulmonary syndrome. All CEPS were ipsilateral to the spleens. Patency of the portal veins in these cases allowed for percutaneous shunt closure with resolution of cyanosis.
  
  
  CONCLUSIONS
  CEPS is associated with heterotaxy with polysplenia and can be symptomatic because of pulmonary arteriovenous (AV) shunting. Portal and hepatic vein patency are critical for determining feasibility of CEPS closure.
authors.affiliation: Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, 725 Welch Road, Stanford, CA 94305, USA. bev.newman@stanford.edu
authors.forename: Beverley
authors.initials: B
authors.lastname: Newman
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Feinstein
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Cohen
authors.forename: Brian
authors.initials: B
authors.lastname: Feingold
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kreutzer
authors.forename: Hitendra
authors.initials: H
authors.lastname: Patel
authors.forename: Fandics P
authors.initials: FP
authors.lastname: Chan
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis*; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D011859:Radiography; D013154:Spleen / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000000981:diagnostic imaging*