Measurement of hepatic vein pressure gradient in children with chronic liver diseases.
OBJECTIVE
The aim of this study is to present our preliminary experience with Hepatic Vein Pressure Gradient (HVPG) measurements in pediatric patients with chronic liver disease.


METHODS
Institutional review board approval was obtained. HVPG was measured in 20 pediatric patients, mean age 82+/-54 months, with chronic liver disease, without extrahepatic portal vein obstruction. In nine patients the end-stage liver disease was secondary to biliary atresia; in the remaining 11, to various causes. Eleven patients had esophageal varices at endoscopy, 14 had perigastric and periesophageal collaterals at imaging scan, three had ascites, 12 had low platelet count, and all had splenomegaly.


RESULTS
Hepatic vein catheterization was technically possible in all patients without complications. HVPG values were elevated in all but three patients, ranging between 2 and 33 mmHg (mean 11.3+/-7.2 mmHg), thus indicating a sinusoidal component in portal hypertension. A salient finding was the presence of hepatic venovenous shunts in 7 out of 9 patients with biliary atresia; however, the HVPG could still be measured distal to the shunts, but in three patients (with an HVPG of 8 mmHg) it was determined in an area with a small venovenous communication still visible, therefore underestimating the actual portal pressure gradient. No venovenous shunts were detected in the non-biliary atresia patients.


CONCLUSIONS
HVPG is a feasible procedure in pediatric patients. Patients with biliary atresia very frequently have communicating vessels between hepatic veins. This hitherto unacknowledged finding can lead to the underestimation of portal pressure by HVPG measurement.
Miraglia
Roberto
R
Department of Diagnostic and Interventional Radiology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, University of Pittsburgh Medical Center, Palermo, Italy. rmiraglia@ismett.edu
Luca
Angelo
A
Maruzzelli
Luigi
L
Spada
Marco
M
Riva
Silvia
S
Caruso
Settimo
S
Maggiore
Giuseppe
G
Gridelli
Bruno
B
Bosch
Jaime
J
D002675:Child, Preschool; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology; D008107:Liver Diseases / Q000503:physiopathology*; D008297:Male; D014690:Venous Pressure