Investigation of right lobe hepatic vein
variations of donor using 64-detector computed tomography before living donor liver transplantation.
Her permanent catheter had been inserted in another medical center and we investigated that the catheter was extended towards the middle hepatic vein
using computed tomography (CT).
For the second stage, the right hepatic vein
was transected with a vascular staple, and the right hepatic artery and right hepatic canal, which had been saved during the first stage, were tied with 2/0 silk sutures.
Due to the timely CPR, the air embolus had already left the lung and migrated to the hepatic vein
and inferior vena cava with blood.
The IVC, on the other hand, develops as an amalgamation of several embryologic venous channels with the common hepatic vein
, which gives rise to the hepatic segment of the IVC.
We also assessed the suitability of CT protocol for hepatic vein
presentation, possibilities for its optimization, and the value of CT as an imaging method for surgical treatment planning.
Following this, a 10x80 mm (60 mm covered and 20 mm uncovered) VIATORR stent was placed through the Express LD stent, extending from the portal vein to the hepatic vein
A3: Stent was implanted among the inferior vena cava, hepatic vein
, preshunt channel, and portal vein to establish a shunt (white arrow).
Additionally, high RAP was suspected based on hepatic vein
enlargement and abnormal hepatic vein
flow pattern (i.e., systolic flow velocity (Vs)/diastolic flow velocity (Vd) < 1 (predominant diastolic)).
Right cardiac catherization (mmHg) Initial RA 5, PA 31/15 (mean 22) After albumin RA 13, PA 57/30 (mean 39), PWP 20, CO 5.5 L/min PFTs DLco 9.33 L, VC 2.75 L Portal pressure measurements (mmHg) Initial after albumin FHVP 16, WHVP 17, HVPG 1 Pre-TIPS without FHVP 2, WHVP 4, HVPG 5, albumin PVP 15, PPG 11 Post-TIPS FHVP 5, WHVP 7, HVPG 2, PVP 14, PPG 7 RA: right atrial pressure, PWP: pulmonary wedge pressure, CO: cardiac output, FHVP: free hepatic vein
pressure, WHVP: wedge hepatic vein
pressure, HVPG: hepatic vein
pressure gradient, PVP: direct portal venous pressure measurement, PPG: portal pressure gradient (PVP minus WHVP), PFTs: pulmonary function tests, DLco: diffusion capacity of carbon dioxide, VC: vital capacity, TIPS: transjugular intrahepatic portosystemic shunt.
However, the causes of PH vary with patients, and the structure of intrahepatic vascular system, especially the spatial relationship between hepatic vein
and portal vein, also varies with patients.
It is usually seen in cardiac involvement but it can be also seen due to inferior vena cava (IVC) or hepatic vein