Prognostic Implications of the Degree of Shunt Narrowing and of the Portal Vein Diameter in Dogs with Congenital Portosystemic Shunts

Kummeling, Anne; Sluijs, F.J. van; Rothuizen, J.

doi:10.1111/j.1532-950x.2004.04004.x

Cited by 63 publications

(119 citation statements)

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“…The pathogenesis of the encephalopathy is multifactorial in both species, but hyperammonemia is a common major factor. In man and in dogs the severe brain dysfunctions caused by hepatic encephalopathy are transient and can be completely resolved upon successful surgical closure of the congenital shunt (Alonso-Gamarra et al 2011; Hunt 2004; Kummeling et al 2004). …”

Section: Congenital Portosystemic Shunts In Man and Comparison With Dogsmentioning

confidence: 99%

Inherited liver shunts in dogs elucidate pathways regulating embryonic development and clinical disorders of the portal vein

et al. 2011

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Congenital disorders of the hepatic portal vasculature are rare in man but occur frequently in certain dog breeds. In dogs, there are two main subtypes: intrahepatic portosystemic shunts, which are considered to stem from defective closure of the embryonic ductus venosus, and extrahepatic shunts, which connect the splanchnic vascular system with the vena cava or vena azygos. Both subtypes result in nearly complete bypass of the liver by the portal blood flow. In both subtypes the development of the smaller branches of the portal vein tree in the liver is impaired and terminal branches delivering portal blood to the liver lobules are often lacking. The clinical signs are due to poor liver growth, development, and function. Patency of the ductus venosus seems to be a digenic trait in Irish wolfhounds, whereas Cairn terriers with extrahepatic portosystemic shunts display a more complex inheritance. The genes involved in these disorders cannot be identified with the sporadic human cases, but in dogs, the genome-wide study of the extrahepatic form is at an advanced stage. The canine disease may lead to the identification of novel genes and pathways cooperating in growth and development of the hepatic portal vein tree. The same pathways likely regulate the development of the vascular system of regenerating livers during liver diseases such as hepatitis and cirrhosis. Therefore, the identification of these molecular pathways may provide a basis for future proregenerative intervention.

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Section: Congenital Portosystemic Shunts In Man and Comparison With Dogsmentioning

confidence: 99%

Inherited liver shunts in dogs elucidate pathways regulating embryonic development and clinical disorders of the portal vein

et al. 2011

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“…In many dogs with CPSS, hepatic function is completely restored after surgical attenuation of the shunt. However, portosystemic shunting, with or without clinical disease, persists in 10–20% of dogs, regardless of the surgical technique used for shunt closure 4–6 . The ability of the liver to adapt to the increased blood flow after shunt attenuation and to grow to normal size may contribute to recovery in individual patients 4,5,7 .…”

mentioning

confidence: 99%

“…However, portosystemic shunting, with or without clinical disease, persists in 10–20% of dogs, regardless of the surgical technique used for shunt closure 4–6 . The ability of the liver to adapt to the increased blood flow after shunt attenuation and to grow to normal size may contribute to recovery in individual patients 4,5,7 . In dogs with CPSS, diagnostic imaging techniques frequently are used for pre‐ and postoperative assessment of the anatomy of the shunt and development of the liver and portal vein 8–11 .…”

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Hepatic Volume Measurements in Dogs with Extrahepatic Congenital Portosystemic Shunts before and after Surgical Attenuation

Kummeling¹,

Vrakking²,

Rothuizen³

et al. 2010

Veterinary Internal Medicne

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Background: In dogs with congenital portosystemic shunts (CPSS), the ability of the hypoplastic liver to grow is considered important for recovery after surgical shunt attenuation.Objectives: This study investigated hepatic growth after extrahepatic shunt attenuation in dogs using magnetic resonance imaging (MRI) and computed tomography (CT).Animals: Ten client-owned dogs with single extrahepatic CPSS. Methods: Abdominal MRI, CT, or both were performed before and 8 days, 1, and 2 months after shunt attenuation. Liver volumes were calculated from the areas of the MRI or CT images.Results: Before surgery, median liver volume was 18.2 cm 3 /kg body weight. Liver volume increased significantly after surgery. Growth was highest between days 0 and 8 and decreased afterward. Median liver volume was 28.8 cm 3 /kg at 2 months after attenuation. No significant differences in growth were found between dogs with complete or partial shunt closure or between dogs with complete or incomplete metabolic recovery. Volumes measured from consecutively performed MRI and CT images correlated well (r 5 0.980), but volumes from MRI images were significantly larger than volumes from CT images (6.8%; P 5 .008).Conclusion and Clinical Importance: After shunt attenuation, rapid normalization of liver size was observed. Hepatic growth was not decreased in dogs after partial closure of CPSS or in dogs with subclinical, persistent shunting 2 months after surgery. CT is the preferred imaging method for volumetric estimation because of speed.

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“…Whilst the sample size in this study is small, it does suggest that the cats with prolonged PT and aPTT tests prior to surgery are not at increased risk of developing a clinical perioperative bleeding complication. There are reports of dogs with CPSS suffering serious or fatal postoperative haemorrhage, [13][14][15]30 but overt bleeding is overall an uncommon complication in animals with a CPSS, severe liver disease or failure. 1,3,5,8,31 One possible theory for why many of these animals do not become hypocoagulable is that the pro-coagulant system is not affected in isolation.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,4,9,12,13 Incidences of haemorrhage, as a result of coagulopathy, in dogs undergoing surgery for CPSS attenuation have been documented but are rare in the literature. [13][14][15] The red blood cell parameters for cats with CPSS are reported in four studies including 130 cats in total with 25-54% having a microcytosis, and 0-15% being anaemic, [16][17][18][19] In one study, 33% of cats had microcytosis without a concurrent anaemia. 19 There is less information regarding coagulation parameters in cats with a CPSS with, to the authors' knowledge, only one study reporting the haematology and coagulation parameters of a series of six cats with portal vein thrombosis, three of which were ultimately diagnosed with CPSS.…”

Section: Introductionmentioning

confidence: 99%

Haematology and coagulation profiles in cats with congenital portosystemic shunts

Tzounos

Tivers

Adamantos

et al. 2017

Journal of Feline Medicine and Surgery

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms Results: Fourty-two cats were included. Thirty-six cats (87.5%) had an extrahepatic CPSS and six (14.3%) had an intrahepatic CPSS. Pre-operatively, mean cell volume (MCV) and mean cell haemoglobin (MCH) were below the reference interval in 32 (76.2%) and 31 (73.8%) cats respectively. Red blood cell count (RBC) and mean cell haemoglobin concentration (MCHC) were above the reference interval in 10 (23.8%) and eight (19.1%) cats respectively. Postoperatively, there were significant increases in HCT (P = 0.044), MCV (P = 0.008) and MCH (P = 0.002). Despite the significant increase in MCV post-operatively, the median MCV post-operatively was below the reference interval indicating persistence of microcytosis. Preoperatively, PT was above the upper reference interval in 14 cats (87.5%), and aPTT was above the upper reference interval in 11 cats (68.7%). No cat demonstrated a peri-operative clinical bleeding complication. Haematology and Coagulation Profiles in Cats with Congenital Portosystemic Shunts Conclusions:Cats with a CPSS are likely to present with a microcytosis, but rarely present with anaemia, leukocytosis or thrombocytopenia. Surgical attenuation of the CPSS results in a significant increase in the HCT and MCV. Coagulation profiles in cats with a CPSS are likely to be prolonged, irrespective of shunt type, but do not appear to be associated with an increased risk of clinical bleeding.MANUSCRIPT

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Prognostic Implications of the Degree of Shunt Narrowing and of the Portal Vein Diameter in Dogs with Congenital Portosystemic Shunts

Abstract: Determination of factors that predict the outcome after surgical treatment of CPS in dogs is important to gain insight in treatment selection or new therapeutic options.

Cited by 63 publications

References 23 publications

Inherited liver shunts in dogs elucidate pathways regulating embryonic development and clinical disorders of the portal vein

Inherited liver shunts in dogs elucidate pathways regulating embryonic development and clinical disorders of the portal vein

Hepatic Volume Measurements in Dogs with Extrahepatic Congenital Portosystemic Shunts before and after Surgical Attenuation

Haematology and coagulation profiles in cats with congenital portosystemic shunts

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