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Role of caval venous manipulation in treatment of protein-losing enteropathy

Published online by Cambridge University Press:  01 June 2008

Shaji Menon
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
Donald Hagler
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
Frank Cetta
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
Peter Gloviczki
Affiliation:
Department of Surgery, Division of Vascular Surgery, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
David Driscoll*
Affiliation:
Departments of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, United States of America
*
Pediatric Cardiology, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota, 55905, USA. Tel: 507-284-2511; Fax: 507-284-3968; E-mail: driscoll.david@mayo.edu

Abstract

Protein-losing enteropathy has been associated with the Fontan operation, restrictive cardiomyopathy, constrictive pericarditis, tricuspid valvar stenosis and insufficiency, and superior caval venous obstruction. The mechanism of development of this complication of cardiac disease likely is multifactorial. We report here our experience with 3 patients with protein-losing enteropathy. Two had superior caval venous occlusion. The third patient had undergone an extracardiac Fontan operation, with stenosis of the extracardiac conduit placed to the right pulmonary artery. In all three cases, the complication was resolved by restoring unobstructed flow of blood in the superior or inferior caval vein. Since the aetiology of protein-losing enteropathy associated with cardiac disease is multifactorial, reduction of pressure in the tributaries of the superior caval vein may, in some cases, be curative. It is more difficult to cure the problem when it is associated with the Fontan operation.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

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