HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Safuh Attar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Attar, S. Search for Related Content PubMed Articles by Attar, S.

Ann Thorac Surg 1998;66:1639
© 1998 The Society of Thoracic Surgeons

---

Review of Recent Books

Coarctation of the inferior vena cava

By Solomon Victor, V. Jauanthi, and N. Madanagopalam,

The Heart Institute, Madras, India 1996

213 pp, illustrated, $110.00

ISBN: 81-900682-02

^a Baltimore, Maryland, USA e-mail: sattar@surgery1.ab.umd.edu

Review of recent books

Hepatic venous occlusion was first described by the British internist George Budd (1808–1882) in 1845 and the Austrian pathologist Hans Chiari (1851–1916) in 1899. Since then, the Budd-Chiari syndrome has remained a rare pathologic entity, with a very poor prognosis until two decades ago. Professor Solomon Victor popularized the term "coarctation of the inferior vena cava (IVC)" which describes a group of patients with unexplained hourglass constriction of the IVC around the level of the superior hepatic veins with or without the hepatic venous occlusion, or idiopathic occlusion of the terminal segments of the hepatic veins with minimal or no caval pathology.

The patients with known causes of hepatic venous outflow obstruction are excluded from the coarctation group. The authors stated that the main objective of writing this book is to create more interest in, and greater awareness of, a potentially correctable cause of the Budd-Chiari syndrome, namely occlusion of the suprahepatic segment of the inferior vena cava, the adjacent terminal superior hepatic veins, or both. This entity, possibly congenital or acquired due to infections, such as filariases, is commonly reported from Africa, China, India, Japan, and Nepal, and more recently the United States.

This book is divided into 11 chapters that cover a historical survey of the disease, its prevalence and incidence, primary and secondary causes of Budd-Chiari Syndrome, etiopathogenesis of the disease, clinical presentations, investigative diagnostic studies, various reported classifications of coarctation of the IVC, medical therapy, interventional and surgical treatment, and future projections. It features an extensive bibliography. The color illustrations, images of ultrasound, images of magnetic resonance, venograms of the IVC and hepatic venous system, and operative photographs are well labeled and are of the highest quality.

The various diagnostic methods for coarctation of the inferior vena cava are evaluated critically, comparing the sensitivity of ultrasound, computed tomography, and magnetic resonance in identifying abnormalities of the hepatic veins and IVC. Magnetic resonance imaging was accurate in 85%, ultrasound in 64%, and computed tomography (CT) in 35%. The sensitivity of the radionuclear scan of the IVC was 85.7% and specificity 100%, making it an ideal preoperative study to establish the patency of IVC. The medical treatment is directed toward the alleviation of symptoms and correction of specific etiologic factors, such as control of ascites, stasis ulcers, edema of scrotum or legs, etc. Interventional and surgical treatment consists of caval decompression by balloon dilatation, excision and patch venoplasty, cavolysis, and shunts with liver transplantation for advanced cases.

Of interest to the cardiothoracic surgeon is the thoracoabdominal approach to the vena cava with anterior displacement of the liver in the presence of resistant tissue ascites, and the transthoracic transdiaphragmatic retrohepatic retroperitoneal approach to the proximal and distal cava. Median sternotomy is used when cardiopulmonary bypass is contemplated. Partial extracorporeal circulation using femorofemoral bypass and oxygenation has also been used.

This book is written by some of the world’s most experienced authorities on this topic and is highly recommended for those involved in the care of a currently curable disease.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Safuh Attar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Attar, S. Search for Related Content PubMed Articles by Attar, S.