Congenital portosystemic shunt: A case series.

Abstract

Case presentations: Four patients underwent close follow-up after prenatal diagnosis of congenital portosystemic shunt, identified via ultrasound during the early third trimester. Among these cases, three were associated with fetal growth restriction, and one presented with bilateral talipes. Fetal hemodynamics were largely normal, except for one case with moderate biventricular hypertrophy. Induction of labor was performed in two cases for pre-eclampsia and in one case for severe fetal growth restriction. The fourth case underwent a repeat caesarean section at 37^+ 6 weeks. All newborns demonstrated good adaptation to extrauterine life, remained asymptomatic, and were clinically and hemodynamically stable. Spontaneous closure of the fistulas occurred without the need for surgical intervention.

Discussion: Congenital portosystemic shunt is associated with a wide spectrum of postnatal outcomes, ranging from spontaneous closure to complications such as cardiac overload, metabolic disturbances, and pulmonary hypertension. Prenatal recognition allows appropriate postnatal surveillance and early detection of complications. In this series, all shunts were intrahepatic and closed spontaneously within the first year of life, with favorable clinical outcomes.

Conclusion: Early detection of congenital portosystemic shunt through prenatal screening can lead to improved postnatal outcomes and prognosis. Prenatal Doppler ultrasound can identify congenital portosystemic shunt when careful attention is paid to hepatic vascular anatomy. Prenatal diagnosis of congenital portosystemic shunt is essential for optimising postnatal management.