title: An ultrasonic duplex system facilitates detection of portal hemodynamic changes following selective shunts for esophageal varices.
abstract: We used an ultrasonic duplex system (US system) to assess portal hemodynamics in 52 patients with liver cirrhosis and esophageal varices, who underwent 2 types of distal splenorenal shunt (DSRS), conventional DSRS (group A, 8 patients) or DSRS with splenopancreatic disconnection (group B, 44 patients). The portal blood flow rate (PBF) was determined in 64 out of 70 patients (91.4%) and the shunt flow rate (SVF) in 39 out of 42 patients (92.9%) who had angiographically confirmed patent portal vein and shunt vein, during the peri- and postoperative period. In group A, a remarkably small amount of postoperative PBF (193 ml/min) and a concomitant increase in SVF (1039 ml/min) were evident. Such ultrasonic findings were compatible with a reduction in portal vein diameter, in accordance with the poor portal perfusion grade of the liver, and a transpancreatic stealing of the portal blood flow to the shunt, as evidenced by postoperative angiography. In contrast, the reduction in PBF was minimal, that is 663 ml/min preoperatively to 562 ml/min at discharge, and 536 ml/min at late follow-up, in group B patients. Significant alterations in portal circulation of the group B patients were not evident angiographically. This US system is most useful to assess portal hemodynamics in patients with a selective shunt.
authors.affiliation: Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Iwanaga
authors.forename: M
authors.initials: M
authors.lastname: Hashizume
authors.forename: N
authors.initials: N
authors.lastname: Koyanagi
authors.forename: S
authors.initials: S
authors.lastname: Kitano
authors.forename: K
authors.initials: K
authors.lastname: Sugimachi
authors.forename: K
authors.initials: K
authors.lastname: Inokuchi
mesh_terms: D000328:Adult; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000473:pathology / Q000503:physiopathology*; D013164:Splenorenal Shunt, Surgical; D014463:Ultrasonography