Patients with congenital heart disease (CHD) increasingly are surviving into adulthood. In the United States alone, there are more than one million adult patients living with CHD with the number increasing about 5% each year. With more than 85% of infants with CHD surviving into adulthood with their disease, encounters with these patients in the operating room for cardiac and noncardiac operative procedures is becoming more commonplace. Most of these patients receive corrective surgery early in life, although some may live with uncorrected CHD with no-torelatively mild symptoms and present at a later time in life with symptoms of heart failure or pulmonary hypertension. The authors present an adult patient with uncorrected CHD presenting with late onset of heart failure symptoms. The authors also review the patient's complex congenital heart lesion, transesophageal echocardiography findings, and intraoperative management.

IntroductionHepatic portal venous gas is the presence of gas within the portal venous system that can result from a variety of insults to the gastrointestinal system, and which may be a diagnostic clue to ominous abdominal pathologies, such as acute bowel ischemia or necrosis.CaseWe report a case of a 71-year-old man with acute onset abdominal pain whose initial radiologic testing showed extensive portal venous gas. The patient was managed conservatively with resolution of portal venous gas on day 2 of hospitalization. The findings were consistent with a final diagnosis of hepatic portal venous gas caused by viral gastroenteritis.ConclusionHistory and physical examination along with presenting signs and symptoms, in conjunction with imaging studies, are vital to delineate the cause of hepatic portal venous gas. In the absence of alarming signs and symptoms, hepatic portal venous gas can be conservatively managed without the need for invasive surgical exploration.

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