title: Arterial-venous shunting in liver cirrhosis.
abstract: Controversial data exist in the literature about the presence and clinical relevance of hepatic arterial-venous shunting. An interesting opportunity for reconsidering the problem has been provided by the use, in the study of liver function, of D-sorbitol, a substance whose first-pass hepatic extraction is very high in normal subjects, while being directly related to circulatory alterations in liver cirrhosis. Because of this property, the systemic bioavailability of D-sorbitol during hepatic arterial infusion can be assumed to reflect arterial-venous shunting. Thirteen biopsy-proven cirrhotic patients (ages 35-66 years), who required diagnostic arterial catheterization, entered the study. Patients were studied on two subsequent days, in which a sterile pyrogen-free solution (1.5%) of D-sorbitol was administered by direct low-rate infusion (15 mg/min for 20 min) into the hepatic artery and the systemic circulation, respectively. Urine samples were spontaneously collected for 8-hr periods before and during/after each infusion. The hepatic arterial bioavailability of D-sorbitol was calculated as the ratio between the net cumulative urinary outputs of D-sorbitol after infusions into the hepatic artery and the systemic vein. Observed values confirm the existence and the large variability (0-88.7%) of hepatic arterial-venous shunting in cirrhotic patients.
authors.affiliation: Division of General Medicine A and Centro di Informatica Medica, S. Giovanni Battista Hospital, Turin, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Molino
authors.forename: F
authors.initials: F
authors.lastname: Bar
authors.forename: S
authors.initials: S
authors.lastname: Battista
authors.forename: M
authors.initials: M
authors.lastname: Torchio
authors.forename: A G
authors.initials: AG
authors.lastname: Niro
authors.forename: E
authors.initials: E
authors.lastname: Garello
authors.forename: P
authors.initials: P
authors.lastname: Avagnina
authors.forename: C
authors.initials: C
authors.lastname: Fava
authors.forename: M
authors.initials: M
authors.lastname: Grosso
authors.forename: F
authors.initials: F
authors.lastname: Spalluto
mesh_terms: D000328:Adult; D000368:Aged; D001682:Biological Availability; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D013012:Sorbitol / Q000378:metabolism
chemical_list: D013012:Sorbitol