Computational hemodynamics of portal vein hypertension in hepatic cirrhosis patients

Abstract

Abstract. Portal vein hypertension generally occurs in liver diseases like hepatic cirrhosis. It causes hemodynamic changes that are closely related to liver disease. At advanced stages of hepatic cirrhosis, portal vein hypertension leads to the atrophy of the right lobe of the liver and the hypertrophy of the left lobe through a process that has not yet been fully explained. Based on the hemodynamic changes that are known to occur, we hypothesize that liver volume is related to the distribution of blood flowing from the splenic vein (SV) that carries hepatotrophic factors from the spleen and pancreas. We studied blood flow in the portal vein system to validate this hypothesis through in vitro experimentation and a computational fluid dynamics (CFD) analysis involving both simplified and patient-specific models based on four healthy subjects and two patients with liver cirrhosis. The results confirmed the hypothesis that right-lobe atrophy is significantly influenced by the distribution of blood from the SV. Moreover, the patients with liver cirrhosis had a significantly larger mass fraction of spleen-derived blood in the left portal vein branch (LPV) than healthy subjects, a result consistent with right-lobe atrophy and left-lobe hypertrophy.

The Effect of Puncture Sites of Portal Vein in TIPS with ePTFE-Covered Stents on Postoperative Long-Term Clinical Efficacy

“…On the other hand, however, angulation or block would possibly appear at both ends of the stent, where high-velocity blood flow might cause the eddy, leading to excessive repair of the injured blood vessel endothelium and thrombosis [17]. Second, from a hemodynamic point of view, the laminar shear stress in the left branch of the portal vein induced less turbulence in a stent shunt, reducing the risk of thrombosis [20]. Third, from a physiopathological reason, the distance between the left branch of the portal vein and that of the hepatic vein is shorter, which facilitated the shunt creation and decreased the contact area between the stent and liver parenchyma, reducing the probability of pseudointima hyperplasia and growth of liver parenchyma into the stent [21].…”

Portal Hemodynamics In Hyponatremic Egyptian Cirrhotic Patients

“…At advanced stages of liver cirrhosis, portal hypertension causes atrophy of the right lobe of the liver and the left lobe hypertrophy. The volume of the liver is directly related to hepatic function and the patient's prognosis .The volume of the right lobe represents two-thirds of the total hepatic volume; so, it is important to prevent right hepatic lobe atrophy in order to improve liver function in patients with cirrhosis and portal hypertension [21].…”

Role of Cystatin C and glomerular filtration rate in diagnosis of kidney impairment in hepatic cirrhosis patients

“…Thus, hepatic cirrhosis is often accompanied by functional kidney impairment. [1] However, this impairment may be reversed if early treatment is promptly administered. [2] On the contrary, the continuation and/or progression of kidney impairment and altered hemodynamics may significantly increase the vasoactive substances such as renin-aldosterone, vasopressin, and endothelin and elevate sympathetic nervous system activity, finally leading to hepatorenal syndrome (HRS).…”