Severe Cyanosis After Kawashima Operation Resulting From Congenital Portosystemic Shunt Yuki Nakamura, MD, Mitsuru Aoki, MD, Ikuo Hagino, MD, Hiromichi.

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Severe Cyanosis After Kawashima Operation Resulting From Congenital Portosystemic Shunt Yuki Nakamura, MD, Mitsuru Aoki, MD, Ikuo Hagino, MD, Hiromichi Nakajima, MD The Annals of Thoracic Surgery Volume 93, Issue 4, Pages 1315-1317 (April 2012) DOI: 10.1016/j.athoracsur.2011.08.058 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Coronal contrast-enhanced computed tomography (CT) images in the first phase. (A) Right-sided inferior vena cava (IVC) ascended to cross over the midline in a retroaortic course to join a left-sided inferior vena cava to become the hemiazygous vein at the level of diaphragm. IVCs and the hemiazygous vein were not contrast enhanced, whereas the portosystemic venous connection was contrast enhanced (arrow). (B) The hepatic veins were clearly enhanced by contrast medium. (I, inferior vena cava; H, hemiazygous vein.) The Annals of Thoracic Surgery 2012 93, 1315-1317DOI: (10.1016/j.athoracsur.2011.08.058) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Three-dimensional computed tomography images in the second phase. (A) The congenital portosystemic venous connection (CPVC) originated from a right renal vein (RV), ascending and keeping a straight course. The splenic vein (SV) took a semicircular path. The gastric vein (GV) was engorged. (B) Lateral view from the right side. The CPVC had connections with the splenic vein and the engorged gastric vein (*). (I = inferior vena cava; PV = portal vein.) The Annals of Thoracic Surgery 2012 93, 1315-1317DOI: (10.1016/j.athoracsur.2011.08.058) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions