A CASE OF BUDD-CHIARI SYNDROME-EVALUATION OF PRE- AND POSTOPERATIVE HEMODYNAMICS BY PULSED DOPPLER ULTRASONOGRAPHY

We report a 46-year-old female with Budd-Chiari syndrome associated with intractable ascites. Ultrasonography (US), hepatic venography and cavography showed an obstruction of the confluence of hepatic veins (HV) and severe stenosis of the hepatic portion of the inferior vena cava (IVC). An operation was performed by the suprahepatic approach under partial cardiopulmonary bypass. The severe stenosis of IVC was reopened by finger fracture, and the scar was resected. The obstructed HV was reopened by using forceps. Ringed Gore-Tex patch graft was secured over the incision of IVC. The blood flows by pulsed Doppler US before the operation were 0.73l/min in hepatic veins, 1.59l/min in IVC and 0.70l/min in potal vein. Postoperatively, these values were increased to 1.75l/min, 2.38l/min and 1.26l/min, respectively. Doppler waveform in the hepatic veins and the IVC changed from continuous flow to triphasic one. In this case, pulsed Doppler US was quite useful in evaluating the hepatic hemodynamics before and after the operation, as well as in assessing the therapeutic effects.