Kirubahara Vaheesan

Current diagnosis and management of post-transjugular intrahepatic portosystemic shunt refractory hepatic encephalopathy.

Transjugular intrahepatic portosystemic shunt has evolved into an important option for management of complications of portal hypertension. The use of polytetrafluoroethylene covered stents enhances shunt patency. Hepatic encephalopathy (HE) remains a significant problem after TIPS placement. The approach to management of patients with refractory hepatic encephalopathy typically requires collaboration between different specialties. Patient selection for TIPS requires careful evaluation of risk factors for HE. TIPS procedure‐related technical factors like stent size, attention to portosystemic pressure gradient reduction and use of adjunctive variceal embolization maybe important. Conservative medical therapy in combination with endovascular therapies often results in resolution or substantial reduction of symptoms. Liver transplantation is, however, the ultimate treatment.

Revascularization of chronic occlusive disease of a right pulmonary artery graft

Anomalous aortic origin of the left coronary artery (AAOLCA) is a rare occurrence. This anomaly may lead to myocardial ischemia and, therefore, surgical repair is recommended to improve long-term survival in these patients. We present a case of successful mobilization of an anomalous left main coronary artery, pulmonary artery translocation, and interposition graft to the right pulmonary artery with a late complication of the right pulmonary artery graft occlusion. This case illustrates the difficulty in the recanalization of pulmonary artery graft occlusion and stenosis, and highlights the utility of treatment via a staged approach.