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[Obstruction of the inferior vena cava at the hepatic portion--surgical management and prognosis of 11 cases].

Eleven patients with obstruction of the inferior vena cava at the hepatic portion were reviewed. In these patients, 7 had membranous obstruction and underwent balloon membranotomy. Pressure gradient between inferior vena cava and right atrium was 13.1 +/- 5.1 mmHg (mean +/- S.D.) and after membranotomy, this fell down to 7.0 +/- 1.9 mmHg. Four patients had long segmental obstruction, and cavoatrial bypass grafting with 16 mm ring reinforced Expanded-Polytetrafluoroethylene graft in 3 and bidirectional digital-instrumental membranotomy in one, were done, respectively. In 2 of 7 patients with membranous obstruction, transcardiac membranotomy was followed. These 3 procedures were so effective that pressure gradient between inferior vena cava and right atrium was 11.7 +/- 3.4 mmHg preoperatively, and after operation, this fell down to 1.7 +/- 0.7 mmHg. During the follow-up period from 8 months to 9 years (mean 4 years and one month), all patients are alive with remarkable improvement of clinical symptoms and signs. It is concluded that balloon membranotomy for membranous obstruction and cavoatrial bypass grafting for long segmental obstruction of the inferior vena cava at the hepatic portion would be recommended.