Clinical Significance of Portal Hypertension Diagnosed With Bedside Ultrasound After Cardiac Surgery.
Portal venous flow pulsatility detected by Doppler ultrasound is a sign of congestive heart failure in noncritically ill patients. The assessment of portal and splenic venous flows has never been reported in patients undergoing cardiac surgery.



This is a case series performed in patients undergoing cardiac surgery between February 2014 and February 2015 in which portal and/or splenic venous flows were assessed by the attending anesthesiologist during surgery or by the intensivist after surgery using transthoracic echography in 9 patients or transesophageal echocardiography in 5 patients. Data collection was done retrospectively by reviewing intraoperative and postoperative monitoring documents. The technique of assessment is detailed in this article.



We report the abnormal portal and/or splenic venous flow pulsatility from 14 patients perioperatively. At the time of pulsatility detection, patients had a median cumulative fluid balance of 3.8 L (interquartile range: 0-4.6 L) and a median right atrial pressure of 14.0 mm Hg (interquartile range: 12.0-15.5 mm Hg). In some patients (4/14), signs of right ventricular dysfunction on echocardiography and/or right ventricular pressure monitoring were present.



Doppler evaluation of portal and splenic venous flow using transthoracic echography and transesophageal echocardiography may represent a promising modality to assess end-organ venous congestion in cardiac surgery patients.
From the *Department of Anesthesia and †Intensive Care Unit, Research Centre, Montreal Heart Institute and Université de Montréal, Montreal, Quebec; ‡Department of Nephrology and §Department of Medicine, and Université de Montréal, Montreal, Quebec; ‖Department of Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec; ¶Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec; and #Department of Nephrology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec.
André Y
AY
Denault
William
W
Beaubien-Souligny
Mahsa
M
Elmi-Sarabi
Roberto
R
Eljaiek
Ismail
I
El-Hamamsy
Yoan
Y
Lamarche
Alexandra
A
Chronopoulos
Jean
J
Lambert
Josée
J
Bouchard
Georges
G
Desjardins
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler / Q000379:methods*