Budd-Chiari Syndrome is an unusual disorder caused by occlusion of hepatic venous outflow. This video illustrates the case of a 28 year old man with complete obstruction of the right and middle hepatic veins and incomplete thrombosis of the left hepatic vein. Hepatomegaly, refractory pleural effusion without liver functional failure were present. Liver biopsy demonstrated a mild chronic congestion with fibrosis and reversed lobulation. A side-to-side partial portacaval shunt with an 8mm ring reinforced PFTE interpo-sition graft was performed combined with portal collateral ligation.