title: Exploiting phenotypic plasticity for the treatment of hepatopulmonary shunting in Abernethy malformation.
abstract: An 11-year-old boy presented with exercise intolerance due to chronic hypoxemia. Work-up revealed a diagnosis of hepatopulmonary syndrome (HPS) secondary to a congenital extrahepatic portal-venous shunt (Abernethy malformation). Plasticity in the developing liver was exploited as a strategy for the treatment of HPS. With use of a staged endovascular approach, the portosystemic vascular circuitry was modified in a manner that facilitated progressive growth and development of the severely hypoplastic and underdeveloped intrahepatic portal venous system. After completion of the final procedure, the patient's intrahepatic portal veins were normal in appearance; 2 months later, signs and symptoms of HPS completely resolved. The patient remains free of HPS stigmata after 2 years.
authors.affiliation: Division of Vascular and Interventional Radiology, University of California Los Angeles, David Geffen School of Medicine, 10833 LeConte Ave, Mail Code CHS 172115, Los Angeles, CA 90095, USA. michaelkuo@mednet.ucla.edu
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kuo
authors.forename: Franklin J
authors.initials: FJ
authors.lastname: Miller
authors.forename: Joel E
authors.initials: JE
authors.lastname: Lavine
authors.forename: Michael
authors.initials: M
authors.lastname: Peterson
authors.forename: Michael
authors.initials: M
authors.lastname: Finch
mesh_terms: D002648:Child; D020065:Hepatopulmonary Syndrome / Q000601:surgery*; D006801:Humans; D008297:Male; D011169:Portal Vein / Q000002:abnormalities* / Q000601:surgery*; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome