AN ENORMOUS SHUNT BETWEEN THE PORTAL AND HEPATIC VEINS ASSOCIATED WITH MULTIPLE CORONARY-ARTERY FISTULAS

A 9-year-old boy with a rare combination of multiple coronary artery fistulas and congenital shunt between the portal and hepatic veins (portal-systemic shunt) is presented. The most likely pathogenesis for the portal-systemic shunt in this case was persistence of the ductus venosus as a bypass tract of the portal vein. This shunt is considered as one cause of cardiomegaly and dilatation of the hepatic vein in this case, and careful follow-up is mandatory because this shunt could induce, portal-systemic encephalopathy. © 1990 Springer-Verlag.