Surgical Treatment of Budd-Chiari Syndrome Using an Upper Approach

Abstract

Budd-Chiari syndrome is a disease of impaired hepatic venous outflow that can progress to cirrhosis, portal hypertension, and other progressive liver disorders. To improve the long-term prognosis of Budd-Chiari syndrome, it is important to drainage the hepatic venous outflow, which is the essence of the disease. We herein report a case in which the occluded hepatic veins were successfully drained by direct surgery through a median sternotomy and upper partial laparotomy. A 64-year-old woman was hospitalized for a Budd-Chiari syndrome due to obstruction of the middle and left hepatic veins. She was approached by an upper approach through a median sternotomy and upper partial laparotomy. The inferior vena cava (IVC) was incised through the right atrium under cardiopulmonary bypass. The occluded hepatic veins were buried in liver parenchyma, they could be reopened by excising some volume of liver tissue between IVC and hepatic veins. Then, hepatic veins perfusion was improved.In patients with Budd-Chiari syndrome, which occurred on occlusion of hepatic veins, an upper approach with cardiopulmonary bypass is a valuable technique to improve hepatic veins perfusion.