title: Portopulmonary venous anastomosis in balloon-occluded retrograde transvenous obliteration for the treatment of gastric varices.
abstract: OBJECTIVE
  Several reports have described portopulmonary venous anastomosis (PPVA). However, in balloon-occluded retrograde transvenous obliteration (BRTO), attention has not been paid to paradoxical embolism. The objective of this study was to investigate the existence of a right-left shunt due to PPVA when the drainage vein is occluded by a balloon during BRTO.
  
  
  METHODS
  The subjects were 19 patients who underwent BRTO. Whether PPVA was present was confirmed on balloon-occluded retrograde transvenous venography (BRTV). After BRTV, a retrograde bolus injection of 20 mL of carbon dioxide (CO2 ) via the balloon catheter was performed under balloon occlusion, and the flow of bubbles into both ventricles was observed with four-chamber view echocardiography. During the same balloon occlusion, bolus injection of CO2 into the inferior vena cava was performed, followed by echocardiography.
  
  
  RESULTS
  PPVA was confirmed on BRTV in four patients (21.1%). On echocardiography with retrograde CO2 injection, bubbles were confirmed in the left ventricle in six patients (31.6%). On echocardiography with CO2 injection into the inferior vena cava, bubbles were not confirmed in the left ventricle in any cases.
  
  
  CONCLUSIONS
  When the draining vein was occluded with a balloon and blood flow in a gastrorenal or gastrocaval shunt was stopped during BRTO, PPVA was confirmed in 21.1% of cases on retrograde angiography, and a right-left shunt was confirmed in 31.6% of cases on echocardiography.
authors.affiliation: Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Kariya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komemushi
authors.forename: Miyuki
authors.initials: M
authors.lastname: Nakatani
authors.forename: Rie
authors.initials: R
authors.lastname: Yoshida
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kono
authors.forename: Tomokuni
authors.initials: T
authors.lastname: Shiraishi
authors.forename: Noboru
authors.initials: N
authors.lastname: Tanigawa
mesh_terms: D000328:Adult; D000368:Aged; D021721:Balloon Occlusion / Q000379:methods*; D002245:Carbon Dioxide / Q000008:administration & dosage; D004932:Esophageal and Gastric Varices / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011859:Radiography; D014463:Ultrasonography; D014682:Vena Cava, Inferior
chemical_list: D002245:Carbon Dioxide
keywords: carbon dioxide; esophageal and gastric varices; hypertension; microbubbles; portal