Kariya Shuji, Komemushi Atsushi, Nakatani Miyuki, Yoshida Rie, Kono Yumiko, Shiraishi Tomokuni, Tanigawa Noboru
Department of Radiology, Kansai Medical University, Hirakata, Osaka, Japan.
J Gastroenterol Hepatol. 2014;29(7):1522-7. doi: 10.1111/jgh.12583.
Several reports have described portopulmonary venous anastomosis (PPVA). However, in balloon-occluded retrograde transvenous obliteration (BRTO), attention has not been paid to paradoxical embolism. The objective of this study was to investigate the existence of a right-left shunt due to PPVA when the drainage vein is occluded by a balloon during BRTO.
The subjects were 19 patients who underwent BRTO. Whether PPVA was present was confirmed on balloon-occluded retrograde transvenous venography (BRTV). After BRTV, a retrograde bolus injection of 20 mL of carbon dioxide (CO2 ) via the balloon catheter was performed under balloon occlusion, and the flow of bubbles into both ventricles was observed with four-chamber view echocardiography. During the same balloon occlusion, bolus injection of CO2 into the inferior vena cava was performed, followed by echocardiography.
PPVA was confirmed on BRTV in four patients (21.1%). On echocardiography with retrograde CO2 injection, bubbles were confirmed in the left ventricle in six patients (31.6%). On echocardiography with CO2 injection into the inferior vena cava, bubbles were not confirmed in the left ventricle in any cases.
When the draining vein was occluded with a balloon and blood flow in a gastrorenal or gastrocaval shunt was stopped during BRTO, PPVA was confirmed in 21.1% of cases on retrograde angiography, and a right-left shunt was confirmed in 31.6% of cases on echocardiography.
已有多篇报道描述了门静脉肺静脉吻合术（PPVA）。然而，在球囊闭塞逆行静脉闭塞术（BRTO）中，反常栓塞尚未引起关注。本研究的目的是调查在BRTO期间，当引流静脉被球囊闭塞时，由于PPVA导致的左右分流的存在情况。
研究对象为19例行BRTO的患者。在球囊闭塞逆行静脉造影（BRTV）上确认是否存在PPVA。BRTV后，在球囊闭塞下通过球囊导管逆行推注20毫升二氧化碳（CO₂），并用四腔心切面超声心动图观察气泡进入双侧心室的情况。在相同的球囊闭塞期间，向腔静脉推注CO₂，随后进行超声心动图检查。
4例患者（21.1%）在BRTV上确认存在PPVA。在逆行注入CO₂的超声心动图检查中，6例患者（31.6%）在左心室中确认有气泡。在向腔静脉注入CO₂的超声心动图检查中，所有病例在左心室均未确认有气泡。
在BRTO期间，当用球囊闭塞引流静脉且胃肾或胃腔分流中的血流停止时，逆行血管造影显示21.1%的病例存在PPVA，超声心动图显示31.6%的病例存在左右分流。
