Value of portal wedged venography in pediatric cavernous transformation of portal vein

Abstract

Objective To explore the diagnostic value and feasibility of portal wedged venography for pediatric cavernous transformation of portal vein (CTPV). Methods From September 2014 to October 2015, a total of 8 CTPV children received portal wedged venography. There were 5 boys and 3 girls with a mean age of 5.6 (7/6-8) years. All preoperative liver functions were at level A. The major clinical manifestations included splenomegaly, hematemesis and hematochezia. Results Rex recessus and intrahepatic portal vein with regular and slender shapes were distinctly visualized in 7 patients and all of them underwent mesenteric-to-left portal vein bypass (Rex's). There was no imaging evidence of anastomotic stenosis during a follow-up period of 3-12 months. However, it showed only distal branches of intrahepatic portal vein in another child. Rex recessus and left or right branch were poorly visualized. Splenorenal vein shunt (Warren's) was performed after confirming occlusion of left branch of intrahepatic portal vein. Conclusions Anatomical location, shape and size of intrahepatic portal vein and Rex recessus of pediatric CTPV are well-delineated on wedged hepatic venous portography. And it is an effective tool of detailed preoperative assessments for identifying the candidates of Meso-Rex bypass. Key words: Cavernous transformation of portal vein; Portography; Interventional therapy