Portal Vein Blood Flow Velocity Research Articles

The effect of Daikenchuto on blood flow of the superior mesenteric artery and portal vein in ELBW: A prospective study.

Focal intestinal perforation (FIP) is a devastating complication of premature birth, and extremely low birth weight (ELBW) infants are at highest risk. This study aimed to evaluate the relationship of the superior mesenteric artery (SMA) and portal vein (PV) blood flow velocities to investigate the association between intestinal blood flow and FIP. In addition, the herbal formula Daikenchuto (TJ-100) is expected to improve intestinal blood flow disorders; therefore, we evaluated its effect. We conducted a prospective cohort study of 15 ELBW infants from January 2020 to August 2021. Measured variables included birth weight, 5-minute Apgar score, time of oral feeding initiation, ductus arteriosus (PDA) closure (percent), diastolic and systolic blood pressure, SMA and PV blood flow velocity, and FIP onset data. Fifteen infants were divided into three groups: a non-surgery group (Group I; 6), a surgery group with FIP (Group II; 4), and a TJ-100 administration group (Group III; 5). The main outcome parameters included SMA and PV blood flow velocities with TJ-100. SMA and PV blood flow differed significantly for the SMA of Group I and the SMA and PV of Group III (P < 0.01, P = 0.01, and P = 0.04, respectively). There was a correlation between SMA and PV in Group III (P = 0.03). TJ-100 may increase SMA and PV blood flow and improve intestinal blood flow in ELBW infants at risk of FIP. Therefore, the effects of TJ-100 should undergo further study.

Utilizing ultra-small volume graft in auxiliary liver transplantation for portal hypertension

Objective: To examine the clinical effect of auxiliary liver transplantation with ultra-small volume graft in the treatment of portal hypertension. Methods: Twelve cases of portal hypertension treated by auxiliary liver transplantation with small volume graft at Liver Transplantation Center,Beijing Friendship Hospital, Capital Medical University between December 2014 and March 2022 were studied retrospectively. There were 8 males and 4 females,aged 14 to 66 years. Model for end-stage liver disease scores were 1 to 15 points and Child scores were 6 to 11 points. The grafts was derived from living donors in 9 cases,from split cadaveric donors in 2 cases,from whole cadaveric liver of child in 1 case. The graft recipient body weight ratios of 3 cadaveric donor livers were 0.79% to 0.90%, and of 9 living donor livers were 0.31% to 0.55%.In these cases, ultra-small volume grafts were implanted. The survivals of patient and graft, complications, portal vein blood flow of residual liver and graft, abdominal drainage and biochemical indexes of liver function were observed. Results: All the grafts and patients survived. Complications included outflow tract torsion in 2 cases, acute rejection in 1 case, bile leakage in 1 case, and thyroid cancer at the later stage of follow-up in 1 case, all of which were cured. The torsion of outflow tract was attributed to the change of anastomotic angle after the growth of donor liver. After the improvement of anastomotic method, the complication did not recur in the later stage. There was no complication of portal hypertension. The measurement of ultrasonic portal vein blood flow velocity showed that the blood flow of residual liver decreased significantly in the early stage after operation, and maintained a very low blood flow velocity or occlusion in the long term after operation, and the blood flow of transplanted liver was stable. Conclusions: Auxiliary liver transplantation can implant ultra-small donor liver through compensation of residual liver. This method may promote the development of living donor left lobe donation and split liver transplantation. However, the auxiliary liver transplantation is complex, and it is difficult to control the complications. Therefore, this method is currently limited to centers that are skilled in living related liver transplantation and that have complete ability to monitor and deal with complications.

Sildenafil does not have a significant effect on the portal vein velocity, cross-sectional area, and congestion index in the dog.

In veterinary medicine, sildenafil is most frequently used to treat pulmonary hypertension, but has also been investigated and used as a treatment for congenital megaesophagus and ischemic infarcts. With the increasing use, the effects of sildenafil on the portal vasculature in the dog have not been previously evaluated. The purpose of this study was to evaluate the effects sildenafil has on the portal vasculature, which anecdotally may have caused decreased portal vein pressure in an adult dog. The ultrasound cross-sectional area of the aorta, cross-sectional area of the portal vein, and portal vein blood flow velocity were acquired in dogs prior to administration, and 45, 90, and 120 min after oral administration of sildenafil for the treatment of pulmonary hypertension. Thirteen dogs were enrolled in the study. No statistically significant difference was detected between all measured values and the congestion index at all time points. A trend was identified that demonstrated progressively lower portal vein velocity with each evaluation, but this was not significant. Although this study had a small sample size, sildenafil was not shown to have a significant effect on the size or blood flow velocity of the portal vasculature. The hepatic buffer system, designed to maintain a constant blood flow to the liver, may be a contributing factor, but further studies with a larger sample size will be required for further evaluation.

Detection of liver and spleen stiffness in rats with portal hypertension by two-dimensional shear wave elastography

BackgroundThe measurement of liver stiffness (LS) and spleen stiffness (SS) based on ultrasound elastography can be used for non-invasive assessment of portal hypertension (PH). However, there are few studies on the corresponding mechanism of increased spleen stiffness. Our aim was to use two-dimensional shear wave elastrography (2D-SWE) to evaluate the relationship between LS and SS and the severity of PH in rats. And explore the mechanism of the increase of LS and SS in PH.MethodsSixty male Sprague–Dawley rats were randomly divided into portal hypertension (PH group, n = 45) and normal control (NC group, n = 15). At 12 weeks, LS and SS was detected by 2D-SWE in vivo. Related hemodynamic parameters and portal vein pressure (PVP) was measured. Spleen and liver 2D-SWE detection was performed again after sacrifice. Pathological changes were observed.ResultsThe SS and LS were increased in PH group (P < 0.05). The SS decreased after sacrifice, and what's more the magnitude of SS decline significantly higher in PH group than in NC group (P < 0.05). The correlation between SS and PVP is stronger than LS (r = 0.624, P < 0.001). SS has positive correlation with indexes of hyperdynamic circulation, but LS was weakly. The correlation between SS and the pathological grade (r = 0.633, P < 0.001) was lower than that in LS (r = 0.905, P < 0.001). Multiple linear regression analysis revealed that SS, portal vein inner diameter (PVD) and splenic vein blood flow velocity (SVV) were significantly associated with PH.ConclusionsSpleen and liver measurement by 2D-SWE may be helpful in evaluating PVP. The correlation between SS and PVP is stronger than LS in rats measured by 2D-SWE. Hemodynamic circulation are important in the elevation of SS with portal hypertension. Pathological changes also have a degree of influence, but have more significance for the elevation of LS. SS may be a more effective noninvasive predictor of PH than LS.

Effect of band ligation or combined with tissue adhesive in the treatment of gastroesophageal varices and portal vein blood flow situational changes

42 cases with gastroesophageal varices were prospectively included. The groups were treated with endoscopic band ligation or combined with tissue adhesive. The results showed that the left gastric vein internal diameter, average blood flow velocity and blood flow volume after the treatment of band ligation combined with tissue adhesive were significantly lower than that of the treatment of band ligation alone, and the differences were statistically significant (P < 0.05). Spleen and portal vein internal diameter, blood flow and average velocity, the liver and spleen size, shear wave velocity and liver function grade of the two groups after treatment did not change significantly (P > 0.05). The effective rate of band ligation combined with tissue adhesive in the treatment of esophageal and gastric varices (66.67%, 52.38%) were higher than that of band ligation alone (42.85%, 23.81%) (P > 0.05), and the re-bleeding rate of the latter was higher (9.52% and 19.05%, P > 0.05). Hence, it is suggested that the combined therapy is safe and more effective, and has no apparent effect on liver function and portal hypertension.

Selective Esophagogastric Devascularization in the Modified Sugiura Procedure for Patients with Cirrhotic Hemorrhagic Portal Hypertension: A Randomized Controlled Trial.

Aim Portal hypertension is a series of syndrome commonly seen with advanced cirrhosis, which seriously affects patient's quality of life and survival. This study was designed to access the efficacy and safety of selective esophagogastric devascularization in the modified Sugiura procedure for patients with cirrhotic hemorrhagic portal hypertension. Methods Sixty patients with hepatitis B cirrhotic hemorrhagic portal hypertension and meeting the inclusion criteria were selected and randomly divided by using computer into the selective modified Sugiura group (sMSP group, n = 30) and the modified Sugiura group (MSP group, n = 30). The primary endpoint measurement is the postoperative rebleeding rate. Secondary endpoint measurements included free portal venous pressure, liver Child–Pugh score, liver volume, portal vein width and blood flow velocity, survival rate, quality of life, and dysphagia as well as other complications one year postoperatively. This trial is registered with ChiCTR, number ChiCTR2000033468. Results There was no statistically significant difference in rebleeding rates within one year after surgery between patients in the sMSP and MSP groups (χ = 0.11, p=0.73). In comparison with the MSP group, the Child–Pugh score of liver function in the sMSP group significantly increased (χ = 6.4, p=0.04) and the incidence of dysphagia was significantly reduced (χ = 6.23, p=0.01) one year after surgery. There was a statistically significant difference in the quality of life between the two groups. However, there were no statistically significant differences in free portal venous pressure (MD = −3.44, 95% CI: −7.87 to 0.98, p=0.12), postoperative liver volume (3 months: MD = -258.81, 95% CI: −723.21 to 205.57, p=0.24; 1 year: MD = −320.12, 95% CI: −438.43 to 102.78, p=0.16), postoperative portal vein width (3 months: MD = −0.06, p=0.50; 1 year: MD = 0.17, p=0.21), portal vein flow velocity (3 months: MD = 1.64, p=0.21; 1 year: MD = −1.19, p=0.57), 1-year survival rate (χ = 1.01, p=0.31), and other complications between the two groups. Conclusions Selective esophagogastric devascularization in the modified Sugiura procedure may not lower the incidence of rebleeding in the short term based on our findings. However, it may significantly improve quality of life of patients with cirrhotic hemorrhagic portal hypertension, improve liver function, and reduce postoperative dysphagia.

Transjugular intrahepatic portosystemic shunt combined with agitation thrombolysis in treatment of acute portal vein thrombosis

Objective To study the clinical efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with agitation thrombolysis in treatment of acute portal vein thrombosis (PVT) in patients with liver cirrhosis. Methods The clinical data of 37 cirrhotic patients with acute PVT treated from January 2014 to December 2017 at the First Affiliated Hospital of Henan University of Science and Technology was analyzed. There were 20 males and 17 females with age ranging from 29 to 71 years. The patients were divided into the combined group (n=15) and the anticoagulation group (n=22). The combined group was treated with TIPS combined with agitation thrombolysis anticoagulation. The anticoagulation group was treated with anticoagulation. The changes in liver function and hemodynamics of portal vein of the two group were compared. Follow-up studies included postoperative portal vein patency, bleeding and survival rates of patients. Results The postoperative portal vein pressure and maximum burden of PVT in the combined group were significantly lower than those before operation, and the portal vein maximum blood volume and flow velocity of portal vein were significantly higher than those before operation (all P<0.05). At 2 weeks, 6 months and 12 months after operation, the maximum burden of PVT of the combined group was (13.9±5.4)%, (16.1±5.5)% and (13.8±6.2)%, respectively, which was significantly lower than that of the anticoagulant group (84.1±31.3)%, (85.9±27.6)% and (88.2±39.5)% (all P<0.05). At 2 weeks, 6 months and 12 months after operation, the flow velocity of portal vein of the combined group was (21.6±5.7) cm/s, (16.1±6.3) cm/s and (17.6±4.9) cm/s, respectively, which was significantly higher than that of the anticoagulation group (9.7±4.6) cm/s, (8.1±4.3) cm/s and (8.2±3.5) cm/s (all P<0.05). After operation, 3 patients in the combined group developed recurrence of portal vein thrombosis, while the remaining patients had smooth blood flow in the portal vein and shunt. In the anticoagulation group, only 3 patients had unobstructed portal vein blood flow. The cumulative rate of no gastrointestinal bleeding in the combined group was significantly better than the anticoagulant group. The cumulative survival rate of the combined group was also significantly better than the anticoagulation group (P<0.05). Conclusion TIPS combined with agitation thrombolysis was more effective than the traditional anticoagulant therapy in treatment of acute portal vein thrombosis in cirrhotic patients. Key words: Portal vein; Portosystemic shunt, transjugular intrahepatic; Thrombosis; Agitation thrombolysis

Real-time observation of pathophysiological processes during murine experimental Schistosoma japonicum infection using high-resolution ultrasound imaging

BackgroundHepatosplenic lesion formation is one of the typical clinical symptoms of schistosomiasis japonica. Although it is established that circum-oval granuloma formation mediated by T lymphocytes is the key event triggering the formation of hepatic lesions, the time-course kinetics of disease progression remains to be fully elucidated.MethodsThe real-time process of the pathophysiology of schistosomiasis japonica from the early to late clinical phase was non-invasively observed in a murine experimental infection model using high-resolution ultrasonography. Together with clinical parameters, including body weight and the levels of serum markers of hepatic damage or fibrosis, ultrasonography was used to assess changes in the liver parenchyma and diameter of the portal vein and portal blood flow velocity. In parallel, parasitological parameters were observed, including egg number in the feces and maturation of parasites.ResultsAbnormal high-echo spot patterns in the liver parenchyma, reflecting hepatic fibrosis in ultrasonography, appeared in the liver at 4 weeks post-infection and the pattern became more enlarged and severe over time. This finding was concordant with parasite maturation and initial egg excretion. The serum M2BPGi level markedly increased from 8 weeks post-infection, suggesting sharp deterioration of hepatic fibrosis. At the same time, the diameter of the portal vein, reflecting portal hypertension, became enlarged and reached the peak level at 8 weeks post-infection. Ascites were apparent around the spleen at 9 weeks post-infection, and dilatation of the splenic vein was noted at 10 weeks post-infection. Live adult worms seemed to be detected in the portal vein at 4 weeks post-infection by ultrasonography.ConclusionsWe obtained real-time imaging of the development of hepatosplenic lesions of schistosomiasis japonica in mice. The time-course kinetics of the onset, development, and modulation of each symptom was uncovered. These results are expected to provide new clues for understanding the pathophysiology of human schistosomiasis japonica.

Impact of terlipressin infusion during and after live donor liver transplantation on incidence of acute kidney injury and neutrophil gelatinase-associated lipocalin serum levels: A randomized controlled trial.

Acute kidney injury (AKI) with liver transplantation (LT) is not uncommon. Impact of terlipressin infusion on AKI, hemodynamics, and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL) was studied. Patients (n=50) were randomized (NCT02059460, USA) into two equal groups: terlipressin vs Controls. Terlipressin (1-4μg/kg/h) was administrated for 5days. Intraoperative transesophageal Doppler for hemodynamic management. Renal functions, peak portal vein blood flow velocity (PPV), and hepatic artery resistive index (HARI) were recorded. Plasma NGAL (pNGAL) was measured baseline, 2 and 24hours postreperfusion. Hepatitis C virus (HCV) was the main etiology. Age, sex, model of end-stage liver disease (MELD), and renal functions were comparable. Postoperative AKI incidence and NGAL concentrations were comparable (P>.05) between terlipressin and controls groups (44% vs 48% and 112.5±9 vs 93.1±8ng/mL), respectively, but intraoperative NGAL in both groups increased significantly 2hours postreperfusion (P<.05). The three NGAL readings were comparable (P>.05) between AKI (n=23) and non-AKI developers (n=27). Mean arterial blood pressure (MAP) was maintained in both groups with less systemic vascular resistance (SVR) fluctuations with terlipressin. Median norepinephrine consumption was lower in terlipressin vs controls (8 vs 12mg; P=.04). The PPV and HARI were not affected by terlipressin at any stage (P>.05). Postliver transplant AKI was not prevented by terlipressin use nor predicted by NGAL levels.

Disorders of heart structure and function parameters and hepatolienal blood flow remodeling in patients with virus-induced cirrhosis

To study heart structure and function parameters and hepatolienal blood flow in patients with virus-induced cirrhosis (VIC). 95 patients with VIC (mean age, 38.6; disease duration, 4.5 years) were evaluated. Doppler EchoCG and Doppler ultrasonic examination of hepatolienal vasculature (VIVID E 95 apparatus) were performed. The control group consisted of 19 healthy individuals. Statistical analysis was performed using the Statistica 6.0 software. The study of hepatolienal blood flow showed that the splanchnic artery blood flow velocity was increased by 25%, the hepatic vein blood flow velocity was increased by 13%, and splanchnic arteries and veins were dilated. 24% of VIC patients had moderate pulmonary hypertension associated with a 20% dilatation of inferior vena cava (p=0.007), a 28% increase in hepatic vein blood flow velocity (p=0.0003), and a 13% decrease in portal vein diameter (p=0.001). Four types of left ventricular (LV) geometry were identified: 40% of VIC patients had normal geometry; 17% of patients had concentric hypertrophy; 23% of patients had concentric remodeling; and 19% had eccentric hypertrophy. Features of hepatolienal blood flow were related with the LV geometry type. LV diastolic filling was impaired in 44.3% and RV diastolic filling - in 33% of patients. In patients with VIC, the disturbed diastolic function was associated with 25% reduced hepatic vein blood flow velocity (p=0.05) whereas development of RV diastolic dysfunction was associated with 6% reduced portal vein diameter (p=0.04), 17% dilated portal vein (p=0.006), and 25% decreased portal vein blood flow velocity (p=0.001). Anti-viral therapy resulted in improvement of some hepatolienal blood flow parameters. Parameters of splanchnic circulation were correlated with cardiodynamic parameters with correlation coefficients from 0.51 to 0.95 at p.

The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study.

Background and Aims:Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR). We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters.Methods:After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (n = 25) or terlipressin group (n = 25) with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0–4.0 μg/kg/h to maintain mean arterial pressure (MAP) >65 mmHg and SVR index <2600 dyne.s/cm5/ m2 till day 4. Nor-epinephrine was used as appropriate. Haemodynamic and transoesophageal Doppler parameters (intraoperative), renal function, peak portal vein blood flow velocity (PPV), hepatic artery resistive index (HARI), urine output (UOP), liver enzymes, catecholamine support were compared intra-operatively and 4 days post-operatively. Desflurane administration was guided with entropy.Results:Terlipressin maintained better MAP and SVR (P < 0.01) during reperfusion versus controls (66.5 ± 16.08 vs. 47.7 ± 4.7 mmHg and 687.7 ± 189.7 vs. 425.0 ± 26.0 dyn.s/cm5), respectively. Nor epinephrine was used in 5 out of 25 versus 20 in controls. Urea, creatinine and UOP were significantly better with terlipressin. PPV was reduced with terlipressin post-reperfusion versus controls (44.8 ± 5.2 vs. 53.8 ± 3.9 ml/s, respectively, P < 0.01) without affecting HARI (0.63 ± 0.06 vs. 0.64 ± 0.05, respectively, P > 0.05) and was sustained post-operatively.Conclusion:Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.

Neonatal Portal Venous Blood Flowmetry by Doppler Ultrasound for Early Diagnosis of Ischemia in Intestinal Tract

The aim of this article is to evaluate the utility of portal blood flow and other hemodynamic measurements for early diagnosis of ischemia that may cause necrotizing enterocolitis (NEC). We measured neonatal portal blood flow by Doppler ultrasound and performed hemodynamic examinations in 75 newborns without congenital anomalies. All newborns were followed for 1 month after birth. The average gestational period was 30.5 weeks, and the average birth weight was 1,172 g. A positive correlation was observed between both body weight and the following parameters: portal vein cross-sectional area, blood flow velocity, and portal blood flow volume. A greater coefficient of correlation was observed between the portal vein cross-sectional area and weight in newborns weighing ≤ 1,500 g than in those weighing > 1,500 g. The portal vein cross-sectional area and blood flow velocity changed over time to maintain a fixed portal blood flow volume. The portal vein blood flow demonstrated a poor increase in patients with poor weight gain after birth. Seven infants demonstrated a reduction in portal vein blood flow before the development of abdominal symptoms. Both the cross-sectional area and blood flow velocity decreased over time before the onset of any symptoms of NEC. A significant decline in portal blood flow volume may be useful for the early diagnosis of NEC.

Study of HIF-1α,iNOS and hemodynamic in patients with hepatopulmonary syndrome with portal hypertension

Objective To investigate the relationship between the color doppler sonography and contrast-enhanced echocardiography(CEE)in assessment of intrapulmonary shunting in patients with hepatopulmonary syndrome and HIF-1α,iNOS and portal hemodynamic.Methoods To examine the portal vein diameter and blood flow velocity by color Dop-pler,and intrapulmonary shunting by contrast-enhanced echocardiography(CEE).The expressions of HIF-1α and iNOS in serum were determined by ELISA in the normal,hepatocirrhosis amalgamating HPS and unamalgamating HPS separately.Comparison of HIF-1α and iNOS in plasma was carried out and relationship between the portal hemodynamic and the intra-pulmonary shunting was examined in three groups.Results The levels of HIF-1α and iNOS in hepatocirrhosis amalgamating HPS were higher than those in unamalgamating HPS,the diameter of portal vein dilated and the velocity of portal vein dropped,there was correlation(P＜0.05).There were positive correlation with intrapulmonary shunting.Conclusion The color doppler sonography and contrast-enhanced echocardiography (CEE)which reflected HIF-1α,iNOS and the hemodynamic played an role in developing of HPS,and was available to early examine change of intra-pulmonary vessel. Key words: Ultrasonography; Hypoxia inducible factor-1α; Inducible nitric oxide synthase; Hepatopulmonary syndrome; Intrapulmonary shunting

PREDICTION OF CAPILLARY LEAKAGE IN PATIENTS WITH DENGUE VIRUS INFECTION: WHAT ELSE BESIDES HEMATOCRIT AND PLATELET COUNTS?

INTRODUCTION: Besides clinical examination, hematocrit and platelet counts are often used to predict if a patient with suspected dengue virus infection had dengue hemorrhagic fever. OBJECTIVE: In this study, we investigated the role of Doppler study of the portal vein as a predictor for capillary leakage in these patients. METHODS: Doppler studies of the right portal vein blood flow velocity were performed for 61 patients (aged 10.2 ± 2.9 years; 34 boys and 27 girls) with serologically confirmed dengue virus infection at defervescence. Presence of right pleural effusion was detected by ultrasound in 32 patients 24 to 48 hours later. Binary logistic regression analysis and receiver operating characteristic (ROC) curves were constructed for the following variables as predictors of pleural effusion 24 to 48 hours after defervescence: age, gender, maximum hematocrit level, lowest platelet count, and the velocity of blood flow in the right portal vein (PVDPL). RESULTS: Hematocrit level and PVDPL were independent predictors of pleural effusion. The area under the ROC curve, sensitivity, and specificity for these variables as predictors for right pleural fluid 24 to 48 hours after defervescence are shown in Table 1. CONCLUSIONS: Doppler-derived portal venous blood flow velocity may be used to predict the clinical progression of patients with dengue virus infection. TABLE 1.Variables as Predictors of Pleural EffusionVariablesArea Under ROC CurveCutoffSensitivity, %Specificity, %Hematocrit, %0.79&amp;gt;437283PVDPL, cm/s0.88&amp;lt;15.37279Hematocrit/PVDPL, s/cm0.93&amp;gt;2.668183

HEPATOSPLANCHNIC CIRCULATORY DYSFUNCTION IN ACUTE HEPATIC INFECTION: THE CASE OF DENGUE HEMORRHAGIC FEVER

The mechanism of shock in patients with dengue hemorrhagic fever (DHF) has not yet been fully understood. In this study, we investigated the possibility of splanchnic venous pooling as a contributor for circulatory dysfunction in these patients. Ultrasonographic studies of portal vein and inferior vena cava were done in 45 patients with serologically or PCR-confirmed diagnosis of dengue virus infection. The size of portal vein and inferior vena cava, mean blood flow velocity in the right portal vein, and modified portal vein congestion index were compared between patients with dengue fever (DF, n = 20), DHF without shock (n = 14), and dengue shock syndrome (DSS, n = 11) during the toxic stage, convalescent stage, and at follow-up. The portal vein was significantly more dilated in patients with shock (DSS) than DHF without shock and than DF during the toxic and convalescent stages (P < 0.05), but not at follow-up. The change in the size of inferior vena cava followed the opposite trend (not statistically significant). Portal vein blood flow velocity was lower and congestion index was higher in shock cases (DSS) than DHF without shock and than DF at toxic and convalescent stages (P < 0.01). The differences disappeared at follow-up. Hepatosplanchnic venous pooling and/or dysfunction occur and correlate with the severity of circulatory derangement and shock in patients with DHF. The cause(s) and significance of hepatosplanchnic circulatory dysfunction in DHF and possibly other viral hepatic diseases deserve further study.

Measurement of left portal vein blood-flow velocity by Doppler sonography in a patient with acute fatty liver of pregnancy.

Acute fatty liver of pregnancy was diagnosed in a 32-year-old primipara in her 34th week of gestation. The pulsed Doppler sonogram showed that mean maximum portal blood-flow velocity obtained at the umbilical-point of the left portal vein (the U-point) decreased during the acute phase of the disease and returned to the normal range accompanied by improvement in her condition. Findings of portal blood dynamics obtained by pulsed Doppler sonography and those of the hyperechoic hepatic parenchyma obtained by conventional sonography could prove useful in following up patients in their third trimester of pregnancy.

Effects of different octreotide dosages on splanchnic hemodynamics and glucagon in patients with TIPS.

The aim of this study was to evaluate the hemodynamic effects of octreotide in patients treated with transjugular intrahepatic portosystemic stent shunt in relation to plasma levels of octreotide and glucagon and the correlation between portal pressure and noninvasive Doppler parameters. In 15 fasting patients, we i.v. administered isotonic sodium chloride followed by octreotide 25 microg/h and 100 microg/h, each over 1 h. We measured portal pressure (PP) directly and portal vein blood flow velocity by Doppler ultrasound simultaneously and calculated portal vascular resistance (PVR) and portal venous flow (PVF). Blood samples were taken for glucagon and octreotide (mean +/- SE). Octreotide reduced PP (120': -7.7+/-2.2%, p < 0.01 vs baseline; 180': - 11.4+/-2.1%, p < 0.01 vs baseline) and PVF (120': -21.7+/-31.7%, p < 0.01 vs baseline; 180': -11.6+/-18.1%, p < 0.05 vs baseline). Glucagon decreased with the increase in octreotide levels and showed a correlation with the decrease in PP and with PVF. In patients with a high PVR, we found a close inverse correlation between PP and portal vein blood flow velocity (r = -0.83, p = 0.03) as well as Cl (r = 0.81, p = 0.05), whereas poor correlation was found in patients with low PVR. Octreotide caused a dose-related, moderate but sustained reduction in PP in patients with transjugular intrahepatic portosystemic stent shunt. PVR seems to be an important parameter that influences the efficacy of octreotide and the relation between PP and noninvasive Doppler parameters.

Effects of different octreotide dosages on splanchnic hemodynamics and glucagon in patients with TIPS

OBJECTIVE: The aim of this study was to evaluate the hemodynamic effects of octreotide in patients treated with transjugular intrahepatic portosystemic stent shunt in relation to plasma levels of octreotide and glucagon and the correlation between portal pressure and noninvasive Doppler parameters. METHODS: In 15 fasting patients, we i.v. administered isotonic sodium chloride followed by octreotide 25 μg/h and 100 μg/h, each over 1 h. We measured portal pressure (PP) directly and portal vein blood flow velocity by Doppler ultrasound simultaneously and calculated portal vascular resistance (PVR) and portal venous flow (PVF). Blood samples were taken for glucagon and octreotide (mean ± SE). RESULTS: Octreotide reduced PP (120′: −7.7 ± 2.2%, p < 0.01 vs baseline; 180′: −11.4 ± 2.1%, p < 0.01 vs baseline) and PVF (120′: −21.7 ± 31.7%, p < 0.01 vs baseline; 180′: −11.6 ± 18.1%, p < 0.05 vs baseline). Glucagon decreased with the increase in octreotide levels and showed a correlation with the decrease in PP and with PVF. In patients with a high PVR, we found a close inverse correlation between PP and portal vein blood flow velocity ( r = −0.83, p = 0.03) as well as CI ( r = 0.81, p = 0.05), whereas poor correlation was found in patients with low PVR. CONCLUSIONS: Octreotide caused a dose-related, moderate but sustained reduction in PP in patients with transjugular intrahepatic portosystemic stent shunt. PVR seems to be an important parameter that influences the efficacy of octreotide and the relation between PP and noninvasive Doppler parameters.

Changes in portal venous hemodynamics in patients with severe acute hepatitis over one year.

A wide range of portal vein blood flow velocity (PVV) values can be found in acute hepatitis. We studied course and medical significance of PVV changes in patients with severe acute hepatitis over a 1-year period. Portal venous hemodynamics were studied by Doppler sonography in 90 patients at study enrollment and 3, 6, and 12 months following an episode of severe acute hepatitis. Forty-one survivors who had a maximum PVV at enrollment greater than or equal to the value measured at the third month were classified as the "declining PVV" group. Thirty-six survivors who had a maximum PVV at enrollment less than the value measured at the third month were classified as the "rising PVV" group. Thirteen patients died of acute hepatic failure and were classified as the fatality group. The fatality group had significantly lower maximum PVV, worse liver biochemical test results, and a higher prevalence of ascites at enrollment. In contrast, the declining PVV group showed significantly better liver biochemical test results and a lower prevalence of ascites. There was no significant difference in portal vein blood flow between the rising and declining PVV groups since portal vein diameter increased while PVV decreased. An initially decreased PVV can be found in some patients with severe acute hepatitis and is inversely correlated with the severity of liver damage.

Changes in portal venous hemodynamics in patients with severe acute hepatitis over one year

Purpose A wide range of portal vein blood flow velocity (PVV) values can be found in acute hepatitis. We studied course and medical significance of PVV changes in patients with severe acute hepatitis over a 1-year period. Methods Portal venous hemodynamics were studied by Doppler sonography in 90 patients at study enrollment and 3, 6, and 12 months following an episode of severe acute hepatitis. Results Forty-one survivors who had a maximum PVV at enrollment greater than or equal to the value measured at the third month were classified as the “declining PVV” group. Thirty-six survivors who had a maximum PVV at enrollment less than the value measured at the third month were classified as the “rising PVV” group. Thirteen patients died of acute hepatic failure and were classified as the fatality group. The fatality group had significantly lower maximum PVV, worse liver biochemical test results, and a higher prevalence of ascites at enrollment. In contrast, the declining PVV group showed significantly better liver biochemical test results and a lower prevalence of ascites. There was no significant difference in portal vein blood flow between the rising and declining PVV groups since portal vein diameter increased while PVV decreased. Conclusions An initially decreased PVV can be found in some patients with severe acute hepatitis and is inversely correlated with the severity of liver damage. © 2000 John Wiley & Sons, Inc. J Clin Ultrasound 28:83–88, 2000.