Nonconventional mesocaval prosthetic shunt interposition in refractory case with portal hypertension in a 10-kg female infant

Surgical treatment of portal hypertension in infants is challenging because of the high risk of shunt thrombosis. A 10-kg female infant underwent six failed procedures before being successfully treated by interposition of a 10-mm-diameter prosthetic graft between two 3-mm-diameter splanchnic veins and the inferior vena cava. Follow-up at 10 years demonstrates shunt patency and normal development without rebleeding. An aggressive surgical strategy is justified as long as even nonconventional techniques are available to prevent life-threatening complications of portal hypertension. Prosthetic grafts can be used when no autologous vein graft is available. Decellularized allografts with reduced immunogenicity may also be effective alternative materials. (C) 2018 Annals of Pediatric Surgery.