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Improved neurocognitive function after radiologic closure of congenital portosystemic shunts.

Congenital portosystemic shunts are rare vascular anomalies causing direct shunting of blood from the portal circulation into the central venous circulation (1,2). They are often a consequence of persistence of elements from the fetal circulation, in particular the ductus venosus. Patients with congenital portosystemic shunts often have no signs or symptoms of disease until adulthood, at which time encephalopathy is the leading presenting symptom (3–6). Shunts may be discovered during surgery for other reasons and as incidental findings during sonography or computed tomography. Recent advances in interventional radiology have provided an opportunity to change management strategies from surgical to less invasive interventions (7–9). We report two children with symptomatic portosystemic shunts in whom interventional radiology was used to obliterate the shunts. Clinical symptoms and neurocognitive function improved in both children after the shunts were obliterated and hepatic portal venous perfusion restored.