Coronary vein diameter and flow direction in patients with portal hypertension: evaluation with duplex sonography and correlation with variceal bleeding.

Abstract

The purpose of this study was to compare the diameter of the coronary vein and the direction of flow within it between patients with portal hypertension and control subjects. We used pulsed Doppler sonography to measure the diameter of the coronary vein and to determine the direction of flow within it in 50 control subjects and 50 patients with portal hypertension. The sonographic findings were correlated with the presence of esophageal varices seen at endoscopy and with history of variceal hemorrhage. In control subjects, the diameter of the coronary vein measured up to 6 mm. In patients with portal hypertension, dilatation of the coronary vein (diameter > 6 mm) was seen in only 13 (26%). Hepatofugal flow in the coronary vein was seen in 39 patients (78%) with portal hypertension, 29 (74%) of whom did not have hepatofugal flow in other major veins of the portal system. None of the patients with portal hypertension and hepatopetal flow in the coronary vein had a history of variceal hemorrhage, whereas 40% of those with hepatofugal flow had had variceal hemorrhage. The diameter of the coronary vein may measure up to 6 mm on sonograms of normal subjects. Dilatation of the coronary vein (diameter > 6 mm) does not occur in most patients with portal hypertension, and need not be present for variceal hemorrhage to occur. Hepatofugal flow in the coronary vein is a common and useful Doppler sonographic sign of portal hypertension. Preservation of hepatopetal flow in the coronary vein in patients with portal hypertension may be associated with a low risk of variceal hemorrhage.