The pulsatile portal vein in cases of congestive heart failure: correlation of duplex Doppler findings with right atrial pressures.

Abstract

To better understand portal vein pulsatility in congestive heart failure, the authors compared portal vein spectral patterns to right atrial pressures measured with a Swan-Ganz catheter in 17 adult patients suspected of having congestive heart failure. Portal vein pulsatility was also evaluated in 17 healthy adults. A pulsatility score (scale, 1-5) based on a ratio of minimum to peak portal vein velocity was assigned. A score of 1 indicated continuous, monophasic flow, while a score of 5 indicated that flow reversal was observed with each cardiac cycle. All 17 healthy volunteers had portal vein pulsatility scores of 2 or less. Among the 17 patients suspected of having congestive heart failure, seven had normal right atrial pressure (less than 10 mm Hg) and pulsatility scores of 2 or less. Among the 10 patients with a right atrial pressure of 10 mm Hg or greater, six had pulsatility scores of 3 or greater (sensitivity, 60%; specificity, 100%). Greater than 50% of the variation in portal vein score is explained by changes in right atrial pressure. Review of echocardiograms in 13 of 17 patients showed no significant correlation between the degree of tricuspid regurgitation and portal vein score. Portal vein pulsatility is a sign of elevated systemic venous pressure.

Doppler sonographic diagnosis of severe portal vein pulsatility in constrictive pericarditis: Flow normalization after pericardiectomy

“…In accordance with the observations of Duerinckx et al, 14 we suggest that SPP in cardiac disease may depend neither on the presence of TR nor on that of pulmonary hypertension and that a significantly increased RAP alone may be sufficient to cause SPP. Presumably, the high RAP is responsible for a pressure-related hepatic venous outflow block with subsequent trans-sinusoidal hepatoportal shunting.…”

“…We assume that the high mean RAP of 17 mm Hg in this patient led to increased hepatic venous outflow resistance with subsequent trans-sinusoidal shunting between the hepatic artery and portal vein, similar to the mechanical outflow block that causes SPP in liver cirrhosis and Budd-Chiari syndrome. 3 SPP as a sign of elevated RAP has also been described by Duerinckx et al, 14 who correlated portal vein spectral patterns with RAP measured invasively in patients suspected of having congestive heart failure.…”

Correlation Of Portal Vein Pulsatility Pattern And Severity Of Liver Disease In Patients With Cirrhosis And Portal Hypertension

“…The PI values found by different authors are 0.39+0.1 (Barakat M) 6 , 0.48+0.31 (Gallix BP et al) 12 , 0.22 (Chou LS et al) 13 . Duerinkx et al 14 and Wachsberg et al 11 found PI values in healthy individuals to be <0.61 and <0.54 respectively.…”

Hepatofugal Portal Venous Flow on Doppler Sonography After Liver Transplantation

“…[30][31][32] As is widely appreciated, right atrial motion has little effect on portal vein flow in healthy individuals because the hepatic sinusoid provides adequate buffering against the marked phasic pressure changes transmitted from the right heart. However, if the systemic venous pressure is stronger than the buffering capacity, portal inflow can be interfered with and dampened.…”