Effective shunt closure for pulmonary hypertension and liver dysfunction in congenital portosystemic venous shunt

Uike, Kiyoshi; Nagata, Hazumu; Hirata, Yoshihiro; Yamamura, Kenichiro; Terashi, Eiko; Matsuura, Toshiharu; Morihana, Eiji; Ohkubo, Kei; Ishii, Kanako; Sakai, Yasunari; Taguchi, Tomoaki; Ohga, Shouichi

doi:10.1002/ppul.23944

Cited by 12 publications

(20 citation statements)

References 19 publications

(27 reference statements)

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“…4,5 In addition, long-term reduced blood inflow can lead to liver dysfunction due to hepatic cell malnutrition, manifesting in a wide range of clinical signs. 6,7 Surgical risk assessment therefore mandates an evaluation of possible liver dysfunction. In the case presented above, some laboratorial values indicated the presence of liver disease, rendering the animal at moderate risk for anaesthetic complications, hepatic decompensation and unwanted drugrelated side effects, thus limiting the options on the drugs that could be safely administered.…”

Section: Discussionmentioning

confidence: 99%

“…Dogs with an EHPSS suffer from an altered hepatic circulation, which reduces clearance of analgesics, resulting in a tendency for prolonged recovery time from sedation or general anaesthesia 4,5 . In addition, long‐term reduced blood inflow can lead to liver dysfunction due to hepatic cell malnutrition, manifesting in a wide range of clinical signs 6,7 …”

Section: Discussionmentioning

confidence: 99%

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Opioid‐free anaesthesia for surgical attenuation of a congenital extrahepatic portosystemic shunt in a dog

Cunha

dos-Santos

2023

Vet Record Case Reports

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Animals with impaired hepatic metabolism may experience reduced effect from some anaesthetic drugs and are more prone to developing unwanted side effects. Due to reduced blood flow to the liver, it is important to carefully select anaesthetic drugs in patients with extrahepatic shunt. We present the case in which a dog was submitted for surgical attenuation of congenital extrahepatic portosystemic shunt through placement of an ameroid constrictor. A multimodal regimen was designed in order to provide an opioid‐free anaesthesia, relying on analgesia through a locoregional quadratus lumborum block with bupivacaine. Dexmedetomidine was administered intramuscularly as pre‐anaesthetic medication, propofol was used for the induction and anaesthesia was maintained with isoflurane. The present case describes the first case in which an extrahepatic portosystemic shunt was surgically treated using an opioid‐free anaesthesia in a dog.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opioid‐free anaesthesia for surgical attenuation of a congenital extrahepatic portosystemic shunt in a dog

Cunha

dos-Santos

2023

Vet Record Case Reports

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“…These could be treatable clinical disorders if they can be found in the early-stage, Doppler ultrasound as a non-invasive screening is a first-line option. The further intervention requirements need clinical and imaging assessments, some could be asymptomatic and no needs for treatment except follow-up (21,22).…”

Section: Discussionmentioning

confidence: 99%

Etiology of neonatal cholestasis after emerging molecular diagnostics

Wang¹,

Yang²,

Wang³

2022

Transl Pediatr

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Background: In the pediatric group, most cholestatic patients had disease onset at 0-3 months of age, and more and more are found to have specific genetic defects after failing to obtain a definite diagnosis by routine evaluation. To investigate the etiological diagnosis for the newborns with cholestasis during the neonatal period after emerging molecular tests comprehensively. Methods:We conducted a retrospective study to evaluate clinical characteristics, etiologies and outcomes in infants with neonatal cholestasis after emerging molecular diagnostics from January 1st to December 31st, 2019 in Children's Hospital of Fudan University.Results: There were 160 cases of neonatal cholestasis with mean gestational age (GA) 32.6±4.8 weeks and birth weight (BW) 1,880±991 g, composing 3.4% of total neonatal admissions in 2019. Overall 97.5% (n=156) patients had a definite diagnosis, including 9 obtaining a genetic diagnosis after adding molecular test in routine evaluation, which made the diagnosis rate for cholestasis increased by 5.6%. The most common etiology of cholestasis in the neonatal period was parenteral nutrition-associated cholestasis (PNAC) 48.8% (n=78), followed by cardiovascular and circulatory disorders 18.1%, biliary anatomic obstruction 12.5%, infection 8.7% and genetic disorders 5.6%. PNAC and biliary anatomic obstruction were the most common etiology of cholestasis for preterm and term infants respectively. The mortality rate is 2.5% (n=4) and 91.9% (n=147) patients totally recovery or improve in follow-up. Conclusions:The causes of cholestasis in neonates are complicated, molecular diagnostics can improve the etiological diagnosis for newborns with cholestasis. But still, quite amount of causes are remediable and transient during the neonatal period, gene test may help to rule out genetic causes and enhance confidence in judging prognosis.

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“…PAH is a rare, but serious complication of CEPSS leading to RV failure and death [1,2]. Percutaneous treatment of CEPSS is feasible and allows normalization of the liver function after shunt closure [2,3]; however, the impact on regression of PAH is not well known. Early diagnosis and shunt closure of CEPSS may prevent the progression or even reverse PAH [4], but in most cases, PAH persisted and required PAH-specific therapies [1][2][3]5].…”

mentioning

confidence: 99%

“…Percutaneous treatment of CEPSS is feasible and allows normalization of the liver function after shunt closure [2,3]; however, the impact on regression of PAH is not well known. Early diagnosis and shunt closure of CEPSS may prevent the progression or even reverse PAH [4], but in most cases, PAH persisted and required PAH-specific therapies [1][2][3]5]. No improvement after early CEPSS closure in this case indicates that volume overload and vasoactive substances may not be the only factors responsible for the development of PAH and the PAH worsening may result from the natural progression of pulmonary vascular disease.…”

mentioning

confidence: 99%

Pulmonary arterial hypertension secondary to congenital extrahepatic portosystemic shunt — a serious complication of a rare disease

Migdal¹,

Koleśnik²,

Żuk³

et al. 2021

Kardiol Pol

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Effective shunt closure for pulmonary hypertension and liver dysfunction in congenital portosystemic venous shunt

Abstract: CPSVS closure with PAH-specific therapy successfully controlled PAH. Early CPSVS closure may prevent the occurrence and progression of PAH with CPSVS.

Cited by 12 publications

References 19 publications

Opioid‐free anaesthesia for surgical attenuation of a congenital extrahepatic portosystemic shunt in a dog

Opioid‐free anaesthesia for surgical attenuation of a congenital extrahepatic portosystemic shunt in a dog

Etiology of neonatal cholestasis after emerging molecular diagnostics

Pulmonary arterial hypertension secondary to congenital extrahepatic portosystemic shunt — a serious complication of a rare disease

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