J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 3939KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 88(5): 622-628, 1987

Original article

OBSTRUCTION OF THE INFERIOR VENA CAVA AT THE HEPATIC PORTION
―SURGICAL MANAGEMENT AND PROGNOSIS OF 11 CASES―

Department of Thoracic＆Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan
**) First Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
*) Department of Cardiovascular Surgery, Kansai-Rosai Hospital, Amagasaki, Japan
***) Department of Surgery, The Cardiovascular Institute Hospital, Tokyo, Japan

Keiichi Aoki***), Takashi Miyamoto, Yoshihiro Shimizu*), Hirotaka Murata, Katsuhiko Kawahara, Yoshizumi Oka, Eizo Okamoto**)

Eleven patients with obstruction of the inferior vena cava at the hepatic portion were reviewed. In these patients, 7 had membranous obstruction and underwent balloon membranotomy. Pressure gradient between inferior vena cava and right atrium was 13.1±5.1mmHg (mean±S.D.) and after membranotomy, this fell down to 7.0±1.9mmHg. Four patients had long segmental obstruction, and cavoatrial bypass grafting with 16mm ring reinforced Expanded-Polytetrafluoroethylene graft in 3 and bidirectional digitalinstrumental membranotomy in one, were done, respectively.
In 2 of 7 patients with membranous obstruction, transcardiac membranotomy was followed. These 3 procedures were so effective that pressure gradient between inferior vena cava and right atrium was 11.7±3.4mmHg preoperatively, and after operation, this fell down to 1.7±0.7mmHg.
During the follow-up period from 8 months to 9 years (mean 4 years and one month), all patients are alive with remarkable improvement of clinical symptoms and signs.
It is concluded that balloon membranotomy for membranous obstruction and cavoatrial bypass grafting for long segmental obstruction of the inferior vena cava at the hepatic portion would be recommended.

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