Immediate and long-term portal hemodynamic consequences of small-diameter H-graft portacaval shunt

The Journal of Surgical Research
E E ZervosA S Rosemurgy

Abstract

Effective hepatic blood flow is thought to play a critical role in outcome following portal decompressive procedures. We have shown previously that hepatic arterialization occurs soon after shunting, preserving nutrient flow, but the remote effects of shunting are unknown. The purpose of this study was to determine the effect of small-diameter prosthetic H-graft portacaval shunt (HGPCS) on effective hepatic blood flow (EHF) and portal pressures 1 year from shunt placement. Patients undergoing 8-mm HGPCS had effective hepatic blood flow determined using low-dose galactose clearance preoperatively, postoperatively, and at 1 year postshunt. Portal blood flow, pressures, and portal vein/inferior vena cava pressure gradients were determined intraoperatively before and after shunt placement and at 1 year. Twenty patients undergoing shunting had flows measured. All patients had significant reductions in portal vein/inferior vena cava pressure gradients while effective hepatic flow was maintained immediately postoperatively. At 1 year following shunting, effective hepatic blood flow was significantly lower than both pre- and postoperative rates of flow while portal pressures and gradients were significantly increased. Albumin, choleste...Continue Reading

References

Feb 11, 1992·The Journal of Surgical Research·C V GodellasW R Gower
Jan 1, 1991·American Journal of Surgery·A S RosemurgyR E Kearney
Jan 1, 1988·American Journal of Surgery·R ZeppaA S Livingstone
Nov 1, 1986·The Journal of Surgical Research·W J SchirmerD E Fry
May 1, 1982·Annals of Surgery·W D WarrenJ T Galambos
Jul 1, 1995·American Journal of Surgery·L CapussottiC Fava
Aug 1, 1993·Archives of Surgery·J G Chandler
Jan 1, 1996·American Journal of Surgery·A S RosemurgyM Camps

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Citations

Dec 1, 2009·Journal of Pediatric Surgery·Christophe ChardotAlain Lachaux
May 22, 2003·Current Problems in Surgery·Alexander S Rosemurgy, Emmanuel E Zervos
Mar 12, 2004·The Journal of Surgical Research·Alexander S RosemurgyEmanuel E Zervos

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