title: Hemodynamics of portal venous stenosis before and after treatment in pediatric liver transplantation: evaluation with Doppler ultrasound.
abstract: OBJECTIVE
  The aim of this study was to evaluate portal vein stenosis (PVS) in pediatric liver transplantation (PLT) using Doppler ultrasound (DUS) before and after interventional management for hemodynamic changes.
  
  
  METHODS
  From 2000 to 2010, we encountered 11 PVS cases among 180 PLT that were evaluated using DUS and computed tomography (CT) angiography (CTA); all underwent portal stenting. DUS was used to monitor portal hemodynamics. For the diagnosis of PVS, we investigated multiple parameters including stenotic size (SS), stenotic ratio (SR) (SR [%]=PRE-SS/PRE [PRE=stenotic size]), portal flow velocity ratio (VR) (VR=VS/PRE [PRE=velocity at prestenotic site; VS=peak velocity at stenotic site]), spleen size, and platelet count.
  
  
  RESULTS
  The incidence of PVS was 5.6% (11/180). The PV was 2.5 mm using DUS and 2.7 mm using CTA. The average SR was 65% fitting the criterion. Low prestenotic portal flow<12 cm/sec and high peak velocity in the stenotic segment (up to 147 cm/sec) were observed in 6 cases. The VR value was high at 7.5:1 and there was splenomegaly with thrombocytopenia. After portal vein stenting, hyperperfusion occurred might after reopening the stenosis: the flow increased to an average of 34 cm/sec and then flow decreased slowly to a stable level 2 weeks later. The size of the spleen decreased from 17 to 12 cm and the thrombocytopenia also improved with platelet counts increasing from 67×10(3) to 178×10(3)/μl at 2 months follow-up. The changes in portal flow, portal vein size, spleen size, and platelet count were significant (P<.05).
  
  
  CONCLUSIONS
  PVS is diagnosed using DUS by increased intrahepatic PV dilatation, peak flow at the stenotic site, discrepant VR. Early portal stenting showed a better prognosis. DUS is essential and effective for hemodynamic monitoring and management of PVS.
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: T L
authors.initials: TL
authors.lastname: Huang
authors.forename: T Y
authors.initials: TY
authors.lastname: Chen
authors.forename: L L
authors.initials: LL
authors.lastname: Tsang
authors.forename: H Y
authors.initials: HY
authors.lastname: Ou
authors.forename: C Y
authors.initials: CY
authors.lastname: Yu
authors.forename: C C
authors.initials: CC
authors.lastname: Wang
authors.forename: S H
authors.initials: SH
authors.lastname: Wang
authors.forename: C C
authors.initials: CC
authors.lastname: Lin
authors.forename: Y W
authors.initials: YW
authors.lastname: Liu
authors.forename: C C
authors.initials: CC
authors.lastname: Yong
authors.forename: K W
authors.initials: KW
authors.lastname: Chiu
authors.forename: H L
authors.initials: HL
authors.lastname: Eng
authors.forename: B
authors.initials: B
authors.lastname: Jawan
authors.forename: Y F
authors.initials: YF
authors.lastname: Cheng
authors.forename: C L
authors.initials: CL
authors.lastname: Chen
mesh_terms: D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D010976:Platelet Count; D011169:Portal Vein / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013163:Splenomegaly / Q000209:etiology; D015607:Stents; D013624:Taiwan; D013921:Thrombocytopenia / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy