The Annals of Thoracic Surgery, Vol 48, 409-412, Copyright © 1989 by The Society of Thoracic Surgeons
Transatrial membranotomy for Budd-Chiari syndrome
CH Chang, MC Lee, MJ Shieh, JP Chang and PJ Lin
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
In a 7-year period, transatrial membranotomy was performed in 11 patients
with membranous obstruction of the inferior vena cava. There were 5 men and
6 women, ranging in age from 23 to 53 years. Clinical symptoms included
jaundice in 4 patients, hepatomegaly in 4, leg edema or varicose veins in
10, and venous collaterals over the abdominal and chest wall in all 11
patients. Transatrial membranotomy was performed through a median
sternotomy in all patients. When inferior vena cava venography revealed
that the obstruction was accompanied by long segmental thrombosis,
additional dilation was performed with a Hegar dilator. There was no
surgical mortality. Early operative complications included pulmonary
embolism in 2 patients and bleeding requiring reoperation in 1. In a mean
follow-up period of 30.6 months (range, 2 to 88 months), 9 patients had no
symptoms, transient pericardial constriction developed in 1 patient and
resolved 1 month later, and restenosis of the inferior vena cava developed
in another patient 1 year after the first operation. This latter patient
received a second transatrial membranotomy followed by percutaneous balloon
angioplasty of the inferior vena cava, with a satisfactory result at 8
months follow-up. We conclude that transatrial membranotomy is an effective
and safe procedure for patients with membranous obstruction of the inferior
vena cava.
