• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2009.04a
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• pp.308-308
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• 2009

• Korean Journal of Veterinary Research
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• v.59 no.3
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• pp.171-173
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• 2019

Two dogs presented with vomiting and head pressing. In both dogs, a large vessel was revealed in computed tomography (CT) angiography, which was found to leave the portal vein (PV) cranial to the splenomesenteric confluence and enter the pre-hepatic caudal vena cava cranial to the right renal vein. The flow of portal blood to the liver was not identified. Based on CT angiography, the dogs were suspected to have congenital PV aplasia with portocaval shunting. Diagnostic imaging of potential malformations for PV continuation should be conducted before attempting shunt closure.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.1
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• pp.56-59
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• 2008

Extrahepatic portosystemic shunts, known as Abernethy malformations, were first reported by John Abernethy in 1793. They are classified into two types: Type I refers to a congenital absence of the portal vein and Type II refers to a shunt involving a side-to-side anastomosis with reduced portal blood flow into the liver parenchyma. This malformation is so rare that less than 100 cases have been reported in the medical literature. We report the case of a 13-month-old boy who had a congenital extrahepatic portocaval shunt with a hypoplastic portal vein. This case was complicated with an atrial septal defect and a large hyperplastic nodule in the liver. The patient was diagnosed with a Type II Abernethy malformation. We planned on surgical occlusion of the extrahepatic portocaval shunt. However, six months later, the patient had a sudden onset of a fever of unknown origin and developed hepatic encephalopathy. Although he underwent a liver transplantation, he died of acute hepatic failure.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.1
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• pp.80-85
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• 2019

Purpose: Abernethy malformation is a rare condition, which was first described in 1793 as a congenital extrahepatic porto-systemic shunt (CEPS) directing splanchnic blood flow into the inferior vena cava. Eighty cases have been published so far that reported CEPS, while in Korea, very few cases have been reported. Through this study, we present 6 cases of patients diagnosed with CEPS at Samsung Medical Center and compare these with other such cases published in France and China. Methods: We reviewed clinical, laboratory, and imaging data of 6 children with CEPS in our pediatric clinic between 2004 and 2017. Results: A total of 6 children with CEPS was included in this study, namely, one with type 1a, two with type 1b, and three with type 2 CEPS. The most common presenting symptom was gastrointestinal bleeding (50.0%). Therapeutic interventions included shunting vessel ligation (16.7%) in type 2 CEPS and liver transplantation (16.7%) in type 2 CEPS patient with suddenly developed hepatic encephalopathy. Conclusion: There is no consensus guideline for the optimal management of patients with CEPS. Large-sample studies regarding CEPS are needed to evaluate the characteristics of patients with CEPS and determine the treatment guideline for CEPS.

• Journal of Veterinary Science
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• v.21 no.3
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• pp.44.1-44.10
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• 2020

Background: Congenital portosystemic shunt (cPSS) is one of the most common congenital disorders diagnosed in dogs. Hepatic encephalopathy (HE) is a frequent complication in dogs with a cPSS and is a major cause of morbidity and mortality. Despite HE been a major cause of morbidity in dogs with a cPSS, little is known about the cellular changes that occur in the central nervous system of dogs with a cPSS. Objectives: The objective of this study was to characterise the histological changes in the cerebral cortex and cerebellum of dogs with cPSS with particular emphasis on astrocyte morphology. Methods: Eight dogs with a confirmed cPSS were included in the study. Results: Six dogs had substantial numbers of Alzheimer type II astrocytes and all cases had increased immunoreactivity for glial fibrillary acidic protein in the cerebral cortex, even if there were minimal other morphological changes. Conclusions: This study demonstrates that dogs with a cPSS have marked cellular changes in the cerebral cortex and cerebellum. The cellular changes that occur in the cerebral cortex and cerebellum of dogs with spontaneously arising HE are similar to changes which occur in humans with HE, further validating dogs with a cPSS as a good model for human HE.

• Journal of Veterinary Science
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• v.25 no.3
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• pp.37.1-37.10
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• 2024

Importance: The portal vein to aorta (PV/Ao) ratio is used to assess the clinical significance of extrahepatic portosystemic shunt (EHPSS). Previous studies using computed tomography (CT) were conducted in dogs but not in cats. Objective: This study aimed to establish normal reference values for PV indices (PV/Ao ratio and PV diameter) in cats and determine the usefulness of these for predicting symptomatic EHPSS. Methods: This study included 95 dogs and 114 cats that underwent abdominal CT. The canine normal (CN) group included dogs without EHPSS. The cats were classified into feline normal (FN, 88/114), feline asymptomatic (FA, 16/114), and feline symptomatic (FS, 10/114) groups. The PV and Ao diameters were measured in axial cross-sections. Results: The group FN had a higher PV/Ao ratio than the group CN (p < 0.001). Within the feline groups, the PV indices were in the order FN > FA > FS (both p < 0.001). The mean PV diameter and PV/Ao ratio for group FN were 5.23±0.77 mm and 1.46±0.19, respectively. The cutoff values between groups FN and FS were 4.115 mm for PV diameter (sensitivity, 100%; specificity, 97.7%) and 1.170 for PV/Ao ratio (90%, 92.1%). The cutoff values between group FA and FS were 3.835 mm (90%, 93.8%) and 1.010 (70%, 100%), respectively. Conclusions and Relevance: The results demonstrated significant differences in PV indices between dogs and cats. In cats, the PV/Ao ratio demonstrated high diagnostic performance for symptomatic EHPSS. The PV diameter also performed well, in contrast to dogs.

• Journal of Veterinary Clinics
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• v.37 no.2
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• pp.82-87
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• 2020

The purpose of this study is to evaluate the azygos vein to aorta diameter ratio (AV/AO ratio) in healthy dogs and dogs with diseases that may cause azygos vein dilation. The normal groups included eleven healthy beagle dogs and eleven small breed dogs. The abnormal group included 43 dogs that had diseases with high right atrial pressure (RA group), obstruction of cranial or caudal vena cava (CVC group) and porto-azygos shunt group (PSS group). The diameter of AV and AO were measured at three sites on thoracic CT images; the level of the cranial endplate of 12^th thoracic vertebra (TV level), the tracheal bifurcation (TB level) and the insertion to the cranial vena cava (CrVC level). The AV/AO ratio at the CrVC level had significantly higher values than those at the TV and TB levels in the normal groups. The AV/AO ratios of TV and TB levels in the CVC group and the values at all measurement sites of the PSS group were significantly higher than the normal groups. AV/AO ratio will be a useful factor for the evaluation of various clinical conditions that change the AV diameter with respect independent to the body weight in dogs.

• Clinical and Experimental Pediatrics
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• v.56 no.11
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• pp.500-504
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• 2013

Here we present the case of an 11-year-old female patient diagnosed with Caroli syndrome, who had refractory esophageal varices. The patient had a history of recurrent bleeding from esophageal varices, which was treated with endoscopic variceal ligation thrice over a period of 2 years. However, the bleeding was not controlled. When the patient finally visited the Emergency Department, the hemoglobin level was 4.4 g/dL. Transhepatic intrajugular portosystemic shunt was unsuccessful. Subsequently, the patient underwent percutaneous transhepatic variceal obliteration. Twenty hours after this procedure, the patient complained of aphasia, dizziness, headache, and general weakness. Six hours later, the patient became drowsy and unresponsive to painful stimuli. Lipiodol particles used to embolize the coronary and posterior gastric veins might have passed into the systemic arterial circulation, and they were found to be lodged in the brain, kidney, lung, and stomach. There was no abnormality of the portal vein on portal venography, and blood flow to the azygos vein through the paravertebral and hemiazygos systems was found to drain to the systemic circulation on coronary venography. Contrast echocardiography showed no pulmonary arteriovenous fistula. Symptoms improved with conservative management, and the esophageal varices were found to have improved on esophagogastroduodenoscopy.

• Journal of Veterinary Clinics
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• v.41 no.1
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• pp.43-48
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• 2024

A two-year-old, intact female Golden Retriever had previously been diagnosed with a portosystemic shunt (PSS) during an ultrasonographic examination at a local animal hospital. The serum biochemistry revealed elevated liver enzymes and bile acid levels. The abdominal radiographic examination revealed mild serosal detail loss and microhepatica, while abdominal ultrasonography revealed mild ascites and high-velocity flow to the caudal vena cava (CVC) suspected as a PSS. The gallbladder was not observed within the hepatic parenchyma during ultrasonography. Computed tomography (CT) revealed an absent gallbladder and dilation of the common bile duct (CBD). Dilations of the gastroduodenal, splenic, colic and renal veins were also observed. A dilated left phrenico-abdominal vein that entered the CVC was previously misinterpreted as a PSS on the ultrasound examination. Based on the imaging examinations, the dog was diagnosed with congenital gallbladder agenesis associated CBD dilation.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.328-330
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• 2002

Large balloon angio catheter is used for Percutaneous Transluminal Angioplsty(TPA) of the iliac, femoral and renal arteries as well as after Transjugular Intrahepatic portosystemic shunt(TIPS). The use of angioplasty balloon filled with liquid form of radioisotope reduces the rate of restenosis after PTA. The purpose of this study was to evaluate the absorbed dose to the target vessels from various sized large balloon filled with liquid form of Ho-166-DTPA. Four balloons of balloon dilatation catheters evaluated were 5, 6, 8 and 10 mm in diameter. GafChromic film was used for the estimation of the absorbed dose near the surface of the balloon catheters. Absorbed dose rates are plotted in units of Gy/min/GBq/ml as a function of radial distance in mm from the surface of balloon. The absorbed dose rate was 1.1, 1.6, 2.2 and 2.3 Gy/min/GBq/ml at a balloon surface, 0.3, 0.4, 0.5 and 0.6 Gy/min/GBq/ml at 1 mm depth for various balloon diameter 5, 6, 8 and 10 mm in diameter respectively. The study was conducted to estimate the absorbed doses to the vessels from various sized large balloons filled with liquid form of Ho-166-DTPA for clinical trial of radiation therapy after the PTA. The absorbed dose distribution of Ho-166 appeared to be nearly ideal for vascular irradiation since beta range is very short avoiding unnecessary radiation to surrounding normal tissues.