The degree of the risk for developing hyperammoniemia after various vascular shunting surgeries in children with portal hypertension

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Abstract

BACKGROUND: Hyperammonemia and hepatic encephalopathy (HE) after portosystemic shunt surgeries in children with portal hypertension (PH) is still a pressing problem in modern pediatric surgery.

AIM: To date, there are very few information in the literature on hyperammonemia prevalence after various vascular bypass surgeries in large groups of patients with PH. To study this problem is an important step in making an adequate choice of treatment modality in children with PH regarding the risk of HE development in future.

METHODS: This paper analyzes the results of studies of ammonia content in venous blood in 173 children, of whom 153 had PH (most had undergone vascular bypass surgery).

RESULTS: The analysis performed has shown that the risk of hyperammonemia in non-operated patients with PH is low, but it increases after certain vascular bypass surgeries on the portal system vessels. To the least extent, this applies to the physiological mesoprotal shunt (MPS) and selective distal splenorenal anastomosis (DSRA), and to the greatest extent — to total portosystemic shunts: splenorenal anastomoses (SRA) (side-to-side splenorenal anastomosis, splenosuprarenal anastomoses) and mesocaval shunt (MCS).

CONCLUSION: Our findings have confirm advantages (low risk of hyperammonemia in childhood) of the mesoportal shunt and distal splenorenal anastomosis compared to splenorenal anastomoses and mesocaval H-shunt. At the same time, the study proves the effectiveness of reconstruction of the splenorenal anastomosis into a distal splenorenal anastomosis in reducing the level of ammonia in the blood (this operation was developed at the N.F. Filatov Children's City Clinical Hospital).

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About the authors

Sergey R. Margaryan

Pirogov Russian National Research Medical University; Filatov Children's City Clinical Hospital

Author for correspondence.
Email: sergey.margaryan27@mail.ru
ORCID iD: 0000-0002-9968-2931
SPIN-code: 6581-9484
Россия, Moscow; Moscow

Lyubov S. Zolotareva

Pirogov Russian National Research Medical University; Filatov Children's City Clinical Hospital

Email: l_zolotareva@mail.ru
ORCID iD: 0000-0001-7662-8257
SPIN-code: 4553-0869

MD, Cand. Sci. (Medicine)

Россия, Moscow; Moscow

Lyudmila V. Pavlushkina

Filatov Children's City Clinical Hospital

Email: lpavlywkina@yandex.ru
ORCID iD: 0000-0002-4738-879X
Россия, Moscow

Zorikto B. Mitupov

Pirogov Russian National Research Medical University; Filatov Children's City Clinical Hospital

Email: zmitupov@mail.ru
ORCID iD: 0000-0002-0016-6444
SPIN-code: 5182-1748

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow; Moscow

Viktor E. Rachkov

Pirogov Russian National Research Medical University; Clinical Hospital Lapino-1 Mother and Child

Email: v.rachkov@mail.ru
ORCID iD: 0000-0002-1304-0592
SPIN-code: 9371-5492

MD, Dr. Sci. (Medicine)

Россия, Moscow; Moscow

Alexander Y. Razumovsky

Pirogov Russian National Research Medical University; Filatov Children's City Clinical Hospital

Email: 1595105@mail.ru
ORCID iD: 0000-0003-3511-0456
SPIN-code: 3600-4701

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the RAS

Россия, Moscow; Moscow

Ekaterina D. Shagina

Pirogov Russian National Research Medical University

Email: shagina_ed@rsmu.ru
SPIN-code: 6217-1782
Россия, Moscow

Fedor V. Shkurov

Sechenov First Moscow State Medical University

Email: shkurov_f_v@student.sechenov.ru
ORCID iD: 0000-0002-6000-0059
SPIN-code: 4588-9910
Россия, Moscow

Anna S. Dudinova

Pirogov Russian National Research Medical University

Email: ann_dudinova@mail.ru
ORCID iD: 0009-0009-3886-9389
SPIN-code: 8566-4962
Россия, Moscow

Galina Y. Chumakova

Filatov Children's City Clinical Hospital

Email: chumakova-g@bk.ru
ORCID iD: 0000-0003-4725-318X

MD, Cand. Sci. (Medicine)

Россия, Moscow

Gheorghe S. Gincu

Nicolae Testemitanu State Medical and Pharmaceutical University

Email: laritei@mail.ru
ORCID iD: 0000-0003-4350-5423
SPIN-code: 8117-4462

MD, Dr. Sci. (Medicine), Assistant Professor

Молдавия, Chisinau

Vera I. Nurik

Pirogov Russian National Research Medical University

Email: vera.nurik@mail.ru
ORCID iD: 0009-0002-6025-1357
SPIN-code: 1431-2990

Assistant Professor

Россия, Moscow

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2. Fig. 1. The average level (Ме) of venous blood ammonia in µmol/l relative to the upper limit of the reference values (orange line) in the groups of subjects.

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