CLOSURE OF HEPATIC CONGENITAL PORTOSYSTEMIC SHUNTS USING CARDIAC CLOSURE DEVICES: A CASE SERIES.

Wood, D.; Ashton, C.; Patel, J.; Rajwal, S.; Mtegha, M.

CLOSURE OF HEPATIC CONGENITAL PORTOSYSTEMIC SHUNTS USING CARDIAC CLOSURE DEVICES: A CASE SERIES.

All Authors

Wood, D.

Ashton, C.

Patel, J.

Rajwal, S.

Mtegha, M.

LTHT Author

Wood, David
Ashton, Chloe
Patel, Jai
Rajwal, Sanjay
Mtegha, Marumbo

LTHT Department

Leeds Children's Hospital
Doctors' Rotation
Radiology
Children's Liver Unit

Publication Date

2025

Item Type

Conference Abstract

Abstract

This report details the first UK-based experience of closing congenital portosystemic shunts (CPSS) using intravascularly deployed cardiac closure devices. The procedure, performed by interventional radiologists at a single specialist centre, involved five paediatric patients between January 2019 and September 2024. CPSS are rare vascular malformations resulting in the bypass of hepatic sinusoidal blood flow.1 2 They can be classified as being extra- or intra-hepatic, and further described by the connecting vessels.1 2 Complications are secondary to physiological compounds evading metabolism within the liver.3 4 This can result in significant morbidity including varying degrees of neurocognitive impairment, hepato-pulmonary syndrome, pulmonary hypertension, liver tumours and endocrine abnormalities.3 4 Approaches to closure were traditionally surgical and have progressed to less invasive methods with interventional radiology avoiding morbidity associated with laparotomy.2 In selected cases, CPSS were deemed unsuitable for endovascular closure with standard available vascular devices. Following careful multidisciplinary team discussion, we considered the use of cardiac septal occluder devices that would best suit the anatomy of the CPSS and avoid laparotomy. We made an application for a new interventional procedure for off-label use of cardiac devices in these patients. Patient families were appropriately consented. Four of the patients received an atrial septal defect occluder and one received a ventricular septal defect occluder. The devices ranged from 9 mm to 27 mm in diameter. Table 1 summarising patient data: These cases highlight the feasibility of using cardiac closure devices in CPSS with anatomy that may seem unsuitable for endovascular closure. Although there have been challenges in initiating a new technique, overall results have been promising and are improving with increased experience.