Extra-hepatic Portosystemic

Extra-hepatic Portosystemic shunt

Meet Sebastian, an 8-month old Chihuahua mix. He was referred to Miami Veterinary Specialists for a consultation with one of our Specialists. He was diagnosed with an extra-hepatic portosystemic shunt or EHPSS (liver shunt) by his primary care veterinarian based on his blood work (elevated liver enzymes and elevated bile acids).

A liver shunt is a blood vessel that carries blood around the liver instead of through it. This results in a small liver due to a decreased blood supply to the liver. It also results in toxic blood being delivered to the heart to be pumped back out to the body and up to the brain because the liver usually cleans the blood. This toxic blood can cause abnormal behaviors such as “star-gazing” and even seizures. In most cases, a liver shunt is a congenital birth defect and in other animals it is acquired due to severe liver disease such as cirrhosis.
He was seen by Dr. Sarah Evans, one of our board-certified surgeons. She discussed Sebastian’s symptoms with his owners, which included: depression, weight loss and diarrhea. Several treatment options were discussed with Sebastian’s owners and it was decided that surgery was the best option for him.

A CT scan was also recommended prior to surgery to help confirm the presence and location of the suspected liver shunt. Sebastian underwent surgery to attenuate or slowly close the shunt vessel. An ameroid ring constrictor was placed around the shunt vessel and a biopsy of Sebastian’s liver was obtained to look for microscopic shunts (microvascular dysplasia).

Sebastian was in the hospital for several days following surgery, being monitored very closely for life-threatening seizures or other complications. He did very well with no complications. Over the following 2-6 weeks, the inner surface of the ameroid ring constricted the shunt vessel, allowing blood to return to the liver. The surgery was a success based on blood work run this week revealing Normal bile acids. More importantly, Sebastian is acting like a normal puppy, full of energy and activity.
“He is doing great!, he is like a new Sebastian!” – Sebastian’s dad.

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