A case of hepatic encephalopathy and pulmonary hypertension due to intrahepatic portacaval shunt

Abstract

Intrahepatic portovenous shunts have been shown up to about 20% in liver cirrhosis, but large shunts between portal and hepatic vein are very rare. We experienced a case 49-year-old man of portovenous shunt within the left lobe discovered by ultrasonography (including pulse Doppler) and confirmed by portography. After ligation of the left branch of portal vein, his symptoms and abnormal laboratory data markedly improved, but shortness of breath has remained still. Postoperative rightsided cardiac catheterization revealed pulmonary arterial pressure vs. systemic pressure (Pp/Ps) unchanged in spite of decreasing of cardiac output.
The etiology of the shunt was thought to be patent ductus venosus for lack of liver disease, portal hypertension and history of trauma. However, occurrence of portal hypertension and aggravation of pulmonary hypertension would have to be followed up carefully after operation.