A Clarification of Some Hemodynamic Changes in Cirrhosis and Their Surgical Significance

Assessment of Portal and Hepatic Hemodynamics after Side-to-Side Portacaval Shunt in Patients with Cirrhosis*

“…Pressure measurements at surgery just before creation of the portacaval shunt did not provide evidence of preoperative retrograde portal venous flow in any of the patients in this report, whereas Warren and Muller found a sinusoidal pressure higher than the free portal pressure in 3 cases out of 7, suggesting preoperative reversal of flow (5). Probably their patients were not a representative sample, since in preoperative pressure measurements by our surgical colleagues, evidence for reversed flow was found in only 7 of 61 patients (10).…”

Plasma Volume in Cirrhosis of the Liver: Its Relation of Portal Hypertension, Ascites, and Renal Failure*

“…Also, in patients with cirrhosis who had portacaval anastomoses without ascites, and who presumably had a decrease in intrahepatic as well as splanchnic congestion as a result of this operation, the mean plasma volume was significantly elevated (p < 0.0001). This elevation occurred even in those patients with side-to-side portacaval anastomoses, which are thought to decongest the liver maximally (35,36) (Figure 1). Those 14 patients with cirrhosis who had portacaval anastomoses proven to be patent at autopsy in four and by catheterization in one, yet who had coexisting ascites, also had an elevated mean plasma volume (51 + 3.0 ml per kg, p < 0.01) (Figure 1).…”

The Effects of Retrograde Portal Venous Flow Following Side-to-Side Portacaval Anastomosis: A Comparison With End-to-Side Shunts*

“…However, one of the subjects had an A-HVo2 difference of 9.9 vol per cent and has not done well clinically following surgery; this may be due to progression of his underlying liver disease or may reflect inadequate sinusoidal perfusion following the shunting procedure. These reports (2,15) indicate variations within the available patient data, and usually a contrast is found between the findings following side-to-side anastomosis in humans with liver disease and in normal dogs. The most likely explanation for these data lies within the distorted parenchymal architecture of Laennec's cirrhosis, which can affect the portal venous radicles or sinusoids to a different degree.…”

“…[1][2][3][4][5][6] was determined by regional indicator dilution studies. Indocyanine green (4) was injected into the FV, PVH and PVG catheters while blood was sampled from either the IVC or HV catheter with a Harvard constant speed withdrawal apparatus.'…”