1992 Volume 34 Issue 11 Pages 2543-2551
Porto-pulmonary venous anastomosis (PPVA) has been evaluated mainly by cineportography. We confirmed PPVA by endoscopic varicealography during injection sclerotherapy (EVIS), and studied its complications. In analyzing the EVIS, PPVA was disclosed in 10 of 230 patients with potal hypertension, 7 males and 3 females. Their ages ranged from 49 to 70 with a mean of 53.5. Nine cases had liver cirrhosis and one had primary biliary cirrhosis. There was no apparent correlation in the duration between the time when diagnosis was made and the time when PPVA was disclosed. In Child's classification, 2 cases were of Child A, 6 of B, and 2 of C. During angiography or EVIS, blood flow appeared hepatof ugal in most cases. Most of the varices in which PPVA was confirmed were of highly risky grade, but bleeding could be controlled in all the cases. In almost all the cases puncture site was confirmed in the lower esophagus, showing a gradient of 9 to 12 clockwise. Four cases had complications; 2 had transient headache, one had transient unconsciousness, and the remaining one had disturbance of consciousness and left hemiplegia. Two of the 4 had diabetes mellitus, and one had primary biliary cirrhosis. All the 4 cases developed cerebrovasucular complications immediately after injection, which indicate shunting to the left heart. Endoscopic injection sclerotherapy should be conducted under varicealography, and when PPVA (which in seen is most of the extra esophageal shounts) is confirmed, certain measures should be taken such as endoscopic balloon be inflated with increasing the volume of air, changing the injection site, or selecting another method, for example, endoscopic variceal ligation.
