PHÂN TẦNG HẸP SHUNT VÀ CHIẾN LƯỢC CAN THIỆP SAU PHẪU THUẬT MESO‑REX BYPASS

Abstract

Background: Meso-Rex bypass (MRB) is a physiological procedure that restores hepatopetal portal venous flow in pediatric patients with portal hypertension secondary to extrahepatic portal vein obstruction. Shunt stenosis is a common complication that may result in hemodynamic failure and eventual shunt thrombosis if not promptly detected and managed. However, reliance on rigid Doppler velocity thresholds may lead to unnecessary interventions.

Objective: To present a practical approach to the assessment of post-MRB shunt stenosis based on shunt velocity stratification combined with clinical findings, and to analyze the decision-making strategy between balloon angioplasty and stent placement.

Methods: A narrative review integrated with clinical experience, focusing on post-MRB shunt hemodynamics, Doppler velocity ranges, and their correlation with clinical response.

Results: Early postoperative high shunt velocities (100–120 cm/s) are often physiological and tend to decrease over time. Shunt stenosis warrants intervention only when persistently elevated velocities (≥150 cm/s) are accompanied by clinical evidence of inadequate portal hemodynamic recovery. Balloon angioplasty is the preferred first-line treatment, whereas stent placement should be reserved for cases of failed angioplasty or high risk of shunt occlusion.

Conclusion: Surveillance of shunt stenosis after MRB should be guided by Doppler velocity trends in conjunction with clinical assessment. A stratified interventional strategy helps avoid overtreatment and optimizes long-term outcomes in pediatric patients.