Portal Vein Blood Flow Research Articles

Combining endoscopic variceal ligation and omeprazole sodium in treating upper gastrointestinal hemorrhage combined with liver cirrhosis

BackgroundCirrhosis, a common chronic liver disease, leads to portal hypertension and complications like ascites and variceal bleeding. Endoscopic variceal ligation (EVL) is the preferred treatment for variceal bleeding. Post-EVL rebleeding due to mucosal irritation from gastric reflux significantly impacts patient prognosis. Omeprazole is an acid-suppressing medication to reduce mucosal damage and improve hemostasis. However, the effect of EVL combined with omeprazole in the treatment of esophageal variceal hemorrhage in cirrhosis remains exploring. Therefore, the present study aims to investigate the value of EVL + omeprazole in treating upper gastrointestinal hemorrhage combined with liver cirrhosis.MethodsOne hundred patients with cirrhosis combined with upper gastrointestinal bleeding (January 2019-December 2022) were included as study subjects. Patients were categorized into observation (50 cases, omeprazole + endoscopic ligation) and control (50 cases, endoscopic ligation) groups. Clinical effects, hemostatic effects, portal venous blood flow, and stress indicators between the two groups were compared.ResultsThe blood transfusion volume, hospitalization time, hemostasis time and rebleeding rate of the observation group were statistically lower than control (P < 0.05). The portal vein blood flow and splenic vein blood flow in both groups after treatment were significantly lower than those before treatment (P < 0.05). The total effective rate of observation group was significantly higher than control (94.0% vs. 80.0%, P < 0.05). Also, the expression of serum amyloid A (SAA), IL-6, procalcitonin (PCT), cortisol (Cor), prostaglandin E2 (PGE2) and C-reactive protein (CRP) in observation group were significantly lower than control (P < 0.05).ConclusionThe combination of EVL and omeprazole effectively manages esophagogastric variceal hemorrhage in cirrhotic patients, enhancing hemostasis, reducing rebleeding, and improving portal hemodynamics.Trial registrationNot applicable.Clinical trial numberNot applicable.

In-Situ Hemodynamics and Oxygen Utilization in Right Lobe Grafts During Living Donor Hepatectomy.

In-Situ Hemodynamics and Oxygen Utilization in Right Lobe Grafts During Living Donor Hepatectomy.

Portal-Vein Compression Caused by Double-Pigtail Plastic Biliary Stent.

Reports of pseudoaneurysms associated with biliary self-expandable metallic stent (SEMS) placement have been increasing. Recently, cases of hepatic pseudoaneurysm rupture caused by double pigtail plastic stents (DPS) have also been reported. The symptoms of pseudoaneurysms are often non-specific, and many cases are diagnosed only after rupture. Therefore, early detection and appropriate treatment are required. A 45-year-old woman presented with obstructive jaundice caused by pancreatic head cancer, with imaging revealing common bile duct stenosis and intrahepatic bile duct dilation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to place a DPS in the left hepatic duct, relieving jaundice. However, follow-up contrast-enhanced computed tomography (CE-CT) revealed differences in arterial-phase blood flow between the liver lobes without reduction in portal vein blood flow. Therefore, the compression and stenosis of the left branch of the portal vein caused by the DPS were clearly identified using three-dimensional computed tomography (3D-CT). The DPS was replaced with a straight-type stent, preventing further complications. The patient subsequently underwent successful pancreaticoduodenectomy without any surgical complications. This is a case of portal vein compression caused by double-pigtail plastic biliary stent. By promptly recognizing the differences in arterial-phase blood flow between the liver lobes and replacing the DPS with a straight-type plastic stent, complications, such as portal vein pseudoaneurysm formation, rupture, embolism, or thrombosis, were successfully avoided.

Features Changes Hemodinamic Liver Easy Preeclampsia

Examine the systemic circulation of the liver and its role in the predicting of preeclampsia. We studied 100 pregnant women with mild preeclampsia (II group), and 50 pregnant women with physiological pregnancy control group (I group), 50 pregnant women with severe PE (III group). Comprehensive ultrasound and Doppler blood flow study was performed, ultrasound scanner Sono-scape SSI 5000 (China model) equipped with Convex probe (3.5 MHz) provided with a pulsed Doppler unit and wave function of the DRC. Examined blood flow in arteries and veins of the liver (liv A, liv V, Col V). Blood flow in the same hepatic portal vein and a tendency towards a certain decrease in pregnant women with PE. LMS and R &amp; D in the hepatic artery, these values were increased by 13.3 and 26.4, respectively, in severe PE. Study features of hepatic arterial blood flow with the emergence of hypertension in pregnancy can be a predictor of the development of PE and its progress with the transition to severe.

A rare case of esophageal variceal bleeding from portal hypertension due to extrahepatic portal vein obstruction in a two-year-old

Extrahepatic portal vein obstruction (EHPVO) is a type of liver vascular disease characterized by cavernomatous transformation and obstruction in the portal veins. Congenital defects, numerous transfusions, trauma, sepsis, dehydration, and hypercoagulable disorders are important risk factors. Since most patients have no symptoms, acute extrahepatic portal vein obstruction is frequently disregarded. Hematemesis and splenomegaly without hepatic decompensation are among the symptoms that might occur in subacute and chronic stages. Imaging studies aid in the diagnosis; Doppler imaging is added to ultrasonography to visualize portal vein blood flow. MRI and CT scans are used to visualize portal vein blockage. Prevention of acute bleeding is the cornerstone in the management. Studies have shown that transhepatic thrombolysis is the preferred choice to avoid systemic side effects. Treatment for extrahepatic portal venous thrombosis involves an intrahepatic portosystemic shunt, which is usually followed by conservative measures to stop variceal haemorrhage. When other forms of therapy are ineffective, liver transplantation is carried out. This case report describes a rare instance of EHPVO in a two-year-old boy who was hospitalized due to recurrent fever, increased belly circumference, and a persistent feeling of fullness in the abdomen. The patient had a surgically placed splenorenal shunt, which helped him respond well to treatment.

Reduced portal vein blood flow velocity in acute fatty liver of pregnancy

PurposeAcute fatty liver of pregnancy (AFLP) is a severe complication that can occur in the third trimester or immediately postpartum, characterized by rapid hepatic failure. This study aims to explore the changes in portal vein blood flow velocity and liver function during pregnancy, which may assist in the early diagnosis and management of AFLP.MethodsThis longitudinal study was conducted at a tertiary healthcare center with participants recruited from routine antenatal check-ups. The study included healthy women aged 20–40 years with singleton pregnancies. Doppler ultrasonography was used to assess portal vein flow and velocity, complemented by standard laboratory tests to monitor liver function. A nomogram model integrating the clinical features and Doppler ultrasonography parameters was constructed using logistic regression analysis for differentiating AFLP from normal controls.ResultsA total of 135 women were enrolled, divided into control and AFLP groups. The AFLP group demonstrated a significant reduction in portal vein flow velocity and alterations in liver dimensions. Laboratory tests indicated elevated liver enzymes and altered lipid profiles in the AFLP group. Statistical analysis showed that portal vein flow velocity could be a sensitive marker for predicting liver dysfunction in AFLP. The area under the receiver operating characteristic (ROC) curves (AUC) of the nomogram model were 0.88 (95% confidence interval [CI]: 0.82–0.95) with specificity, sensitivity, negative predictive value, and positive predictive value of 67.8, 95.0, 95.0, and 67.8, respectively, in the training cohort and 0.86 (95% CI: 0.72–0.98) and 86.9, 75.0, 83.3, and 80.0 in the test cohort, respectively. The calibration curves demonstrated good agreement between the predicted and observed probability for predicting AFLP.ConclusionThe study underscores the potential of using portal vein flow velocity as an early diagnostic marker for AFLP in pregnant women. Further research is required to establish standardized diagnostic thresholds for portal vein flow measurements.

Non Invasive Assessment of Pulmonary Artery Pressure in Children with Portal Hypertension

Abstract Background Pulmonary artery hypertension is a complication of liver cirrhosis with Portal Hypertension (PHT). It has been mentioned in case reports or small series of children. Fewinformation known on its prevalence and long-term survival in childhood liver disease. This study will assess the Pulmonary Atery Pressure (PAP) in children with PHT in Pediatric Hepatologyclinic, Ain Shams University Children Hospital in order to identify clinical characteristics of Porto PH and its prevalence among those children. Aim of the Work To assess the PAP using Echocardiography in children with PHT who attend Pediatric Hepatology clinic, Ain Shams University Children Hospital. Patients and Methods This case-control study was conducted on thirty patients enrolled from Pediatric Hepatology clinic, Ain Shams University Children Hospital in a period of one year from June 2021 to June 2022 according to inclusion criteria : history of hematemesis and melena, clinical examination: Splenomegaly, dilated anterior abdominal wall vessels, ascites ± firm hepatomegaly and imaging: Ultrasonography (US) /color Doppler-US (CDUS): Splenomegaly, presence of Porto collateral vessels and ascites. This information will be completed with data on liver size, echo texture, and margins which can suggest underlying cirrhosis, portal vein diameter, portal blood flow velocity, direction of blood flow in portal vein with age ranging from 1 to 16 years with median (IQR) of 8 (4.5-12) years; they were 11 females (36.7%) and 19 males (63.3%) and thirty healthy matched age and sex as a control group. Results In our study, MPAP was 9.79 ± 2.21 mmHg (7.2-18.2 mmHg). Statistically, there was statistically significant increase in the level of TR velocity, TR PG, RVSP and MPAP in patients with PHT than control group with p-value &amp;lt;0.001, 0.001; 0.001 and &amp;lt;0.001; respectively. Also, there was statistically significant increase in the percentage of patients with abnormal TR PG and patients with elevated systolic PAP in patients with PHT (20.0%) than control group (0.0%) with p-value = 0.010 and 0.010; respectively. Also, there was statistically significant decrease in the level of PA acceleration time (ms) in patients with PHT than control group with p-value &amp;lt;0.001. Also, there was statistically significant increase in the level of PAEDP (mmHg) and LA (cm) in patients with PHT than control group with p-value &amp;lt;0.001 and 0.014; respectively. In our studied group of patients we did not found any of them has PH despite the higher parameters of their Echo studies and that needs follow up of those patients. So the prevalence of PH in those patients is 0%. Conclusion PHT is an important risk factor of development of PH in children. Transthoracic echocardiography can be reliably used as an initial non-invasive, safe and reliable modality for the assessment of pulmonary artery hypertension in children, and can obviate the need of right heart catheterization in some patients, especially those with mild PHT.

Ultrasound criteria for assessing the correction of metabolic-associated fatty liver disease and liver blood flow disorders using arginine in patients with coronary artery disease in combination with COVID-19

Background. Coronavirus disease 2019 (COVID-19) remains one of the most urgent global health problems today. In the conditions of its spread around the world, the global scientific community is trying to study not only respiratory, but also extrapulmonary manifestations of this infection. It is known that with COVID-19, the endothelium, the hemostasis system, and the liver are affected with the occurrence of such a complication as metabolic dysfunction-associated steatotic liver disease (MASLD). The most vulnerable group of patients in terms of coronavirus disease and its complications (including MASLD) are those with coronary heart disease (CAD), therefore the search for effective drugs and optimal ultrasound criteria to evaluate liver steatosis in the dynamics of treatment is the main task of modern medicine. Goal: to determine the ultrasound criteria for assessing the correction of MASLD and liver blood flow disorders using arginine in patients with CAD associated with COVID-19. Materials and methods. A prospective study was conducted in 52 patients with CAD combined with PCR-positive COVID-19. The study was carried out upon admission to the hospital and 6 months after discharge. Group I (n = 27) consisted of CAD + COVID-19 patients who, in addition to standard therapy for MASLD, received arginine for 6 months after discharge from the hospital; group II (comparison group, n = 25) included participants who received standard therapy wi­thout arginine. Results. Splanchnic artery duplex scanning at baseline showed that 21 (78.0 %) patients in group I and 19 (76.0 %) in group II had a decrease in peak systolic velocity (PSV) in the proper hepatic artery (PHA), an increase in portal vein blood flow at the beginning of treatment, as well as increased liver size in 20 (74.0 %) patients in group I and 17 (68.0 %) in group II. An increase in the attenuation coefficient was detected in all patients of groups I and II. There were no differences between the groups at the time of inclusion in the study in terms of splanchnic blood flow and atte­nuation coefficient. After 6 months of arginine treatment, an improvement in the portal vein blood flow and a decrease in blood flow velocity in the PHA, a decrease in the diameter of the portal vein, a decrease in the size of the right and left liver lobes were found in group I, with no improvement in group II. A repeated study revealed a decrease in the attenuation coefficient in group I and no changes in group II. At the beginning of the study, a direct correlation was found between fibrinogen and the attenuation coefficient in group I (r = 0.54; p &lt; 0.05), as well as in group II (r = 0.51; p &lt; 0.05). After 6 months, C-reactive protein decreased in both groups. Conclusions. In patients with CAD combined with COVID-19 in the presence of MASLD, a decrease in the portal vein blood flow and an increase in PSV in the PHA were found. When arginine was used for 6 months in combination with standard therapy, according to the European Society of Cardiology protocols, there was a significant decrease in the attenuation coefficient, PSV in the PHA, and an increase in the portal vein blood flow. This indicates the possibility of using the attenuation coefficient as the main marker, and PSV in the PHA and the portal vein blood flow as additional criteria for ultrasound assessment of MASLD correction with arginine in patients with CAD combined with COVID-19.

A hemodynamic study of the relationship between the left and right liver volumes and the blood flow distribution in portal vein branches.

Cirrhosis patients often exhibit clinical symptoms such as right liver atrophy, portal hypertension, spleen enlargement and increased blood supply, which exhibit considerable variation between the left and right liver sections. These differences are hypothesized to stem from disparities in blood flow within the left and right portal vein (PV) branches. However, rigorous quantitative evidence remains scarce. We mainly aim at quantitatively revealing the relationship between the blood flow rates of two PV branches and liver volumes, and providing quantitative evidence and theoretical support for the diagnosis and treatment of cirrhosis from the perspective of hemodynamics. Five cirrhotic patients and two healthy volunteers from Beijing Friendship Hospital are investigated. Their PV blood flow models are established based on computed tomography (CT) images and finite volume simulations. The volume of the left and right liver lobes are measured in 3-matic. The distributions of blood source in the PV branches are tracked by streamline analysis. The blood flow rates are quantitatively counted by integrating the blood source velocities. Linear analysis is performed to build the relationship between liver volumes and PV blood flow distributions. Streamline analysis reveals significant differences in blood distribution between the left and right PV branches. The majority of blood from the superior mesenteric vein (SMV) flowed into the right portal vein (RPV), while most blood from the splenic vein (SV) entered the left portal vein (LPV). The main PV pressure drop linearly increases with the SV blood velocity for all PV structures of patients and healthy volunteers. The flow rate ratio QRPV/QLPV demonstrates an increase in tandem with the volume ratio VR/VL, exhibiting a linear correlation with the Pearson correlation coefficient being 0.93. The differences in the blood distributions are consistent with the clinicians' knowledge and validate our simulations. We demonstrated a linear increase in PV pressure with elevated SV blood velocity. Additionally, the volumes of the left and right hepatic lobes exhibited a positive correlation with blood flow rates in the corresponding PV branches.

Basketball Anterior and Posterior Portal Veins Doppler Imaging of Sports Medicine Technique Exploration

INTRODUCTION: Basketball, as a high-intensity sport, has attracted much attention for its effects on the cardiovascular system of athletes. The anterior and posterior portal veins are some of the vital blood vessels in the human circulatory system, and their blood flow is closely related to the athletes' physical status. Doppler ultrasound technology is widely used in sports medicine and provides a powerful tool for an in-depth understanding of the effects of basketball on portal vein blood flow. This study aimed to explore the potential of sports medicine technology in assessing cardiovascular adaptations in athletes through portal Doppler imaging before and after basketball exercise.OBJECTIVES: The primary objective of this study was to analyze the effects of basketball exercise on portal vein blood flow in athletes before and after basketball exercise through the use of Doppler ultrasound technology. Specifically, this study aimed to explore the dynamics of pre- and post-exercise Doppler imaging of the posterior and posterior veins in order to assess the cardiovascular adaptations of athletes during exercise more comprehensively and objectively.METHODS: A group of healthy professional basketball players were selected as the study subjects, and Doppler ultrasound instruments were utilized to obtain portal Doppler images before, during, and after exercise. The functional status of the vasculature was assessed by analyzing parameters such as portal blood flow velocity and resistance index. At the same time, the physiological parameters of the athletes, such as heart rate and blood pressure, were combined to gain a comprehensive understanding of the effects of basketball on portal blood flow.RESULTS: The results of the study showed that the anterior and posterior portal blood flow velocities of the athletes changed significantly during basketball exercise. Before the exercise, the blood flow velocity was relatively low, while it rapidly increased and reached the peak state during the exercise. After exercise, blood flow velocity gradually dropped back to the baseline level. In addition, the change in resistance index also indicated that portal blood vessels experienced a particular stress and adaptation process during exercise.CONCLUSION: This study revealed the effects of exercise on the cardiovascular system of athletes by analyzing the Doppler images of the portal vein before and after basketball exercise. Basketball exercise leads to significant changes in portal hemodynamics, which provides a new perspective for sports medicine. These findings are of guiding significance for the development of training programs for athletes and the prevention of exercise-related cardiovascular problems and provide a valuable reference for further research in the field of sports medicine.

Effect of Somatostatin on hepatic blood flow: preliminary results

Background: Somatostatin (SOMATO) administration affects hepatic blood flow (HBF); however, its clinical effect remains ill-defined. The aim of this study is to assess the clinical effects of SOMATO administration on HBF during major abdominal surgery by comparing HBF in patients with and without intra-operative SOMATO admin-istration. Methods: This retrospective analysis used data from two separate prospective studies including patients undergoing pancreaticoduodenectomy and was approved by the Ghent University Hospital ethical committee. All patients received total intravenous an-esthesia, using target-controlled infusion, and guided by a depth of anesthesia monitor. Schnider model was used for propofol, and Minto model was used for remifentanil. All patients received goal-directed hemodynamic therapy guided and recorded by Pul-sioFlex monitoring (Getinge Group). Portal vein blood flow and arterial hepatic blood flow were measured using ultrasound transit time flow measurements (Medi-Stim®). Both PVF and HAF were indexed using cardiac index. Patients were divided in two groups, receiving SOMATO (group S) versus control group not receiving SOMATO (group C). The Shapiro-Wilk test was used for testing normal distribution. Statistical testing was done using a Welch T-test or a Wilcoxon test. Results: From 6/2017 to 10/2020, a total of thirty-seven patients were analyzed. Twenty-five patients received SOMATO (group S) whereas twelve patients did not (group C). In Group S, PVFi was significantly reduced in patients receiving SOMATO compared to the control group (p = 0.005). HAFi was similar in both groups. The net effect on total HBFi was significantly lower in group S (p = 0.027). Hemodynamic parameters did not differ between both groups. Conclusions: SOMATO significantly reduced PVFi in the surgical patients while HAFi remained similar in both groups. As a result, total HBFi was significantly lower in SO-MATO-treated patients.

Relationship Between Spleen Pathologic Changes and Spleen Stiffness in Portal Hypertension Rat Model

Relationship Between Spleen Pathologic Changes and Spleen Stiffness in Portal Hypertension Rat Model

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.

Colour Doppler study of blood flow in the portal vein in relation to blood flow in the milk vein, milk yield and body condition of dairy cows during dry period and lactation

Colour Doppler study of blood flow in the portal vein in relation to blood flow in the milk vein, milk yield and body condition of dairy cows during dry period and lactation

Assessment of hepatic veno-occlusive disease/sinusoidal obstruction syndrome using different scanning approaches for the ultrasonographic evaluation of portal vein blood flow and hepatic artery resistive index in hematopoietic stem cell transplant recipients.

Sinusoidal obstruction syndrome (SOS) is a fatal complication of hematopoietic stem cell transplantation (HSCT). Previously, we established a scoring system (Hokkaido ultrasound-based scoring system-10; HokUS-10) comprising 10 ultrasound parameters for SOS diagnosis. In HokUS-10, the portal vein time-averaged flow velocity (PV TAV) and hepatic artery resistive index (HA RI) are measured using subcostal scanning. However, measurement errors and delineation difficulties occur. Therefore, we aimed to prospectively evaluate PV TAV and HA RI measurements obtained via intercostal scanning as an alternative method to subcostal scanning and determine their cutoff values. HokUS-10 was administered before and after HSCT. PV TAV and HA RI were measured on subcostal and right intercostal scans. We performed 366 scans on 74 patients. The median value (range) of PV TAV in the main and right portal veins was 15.0cm/s (2.2-49.6cm/s) and 10.5cm/s (1.6-22.0cm/s), respectively. A low correlation was observed between the two values (r = 0.39, p < 0.01). The highest diagnostic value of the right portal vein was less than 8.0cm/s. The median value (range) of HA RI in the proper and right hepatic arteries was 0.72 (0.52-1.00) and 0.70 (0.51-1.00), respectively. A strong correlation was observed between the two values (r = 0.65, p < 0.01). The highest diagnostic value of the right HA RI was 0.72 or higher. Quantitative measurement of PV TAV and HA RI using intercostal scanning can be appropriately performed as an alternative method to using subcostal scanning.

Full-Right Full-Left Split Liver Transplantation for Two Adult Recipients: A Single-Center Experience in China

Background: The most effective treatment for end-stage liver diseases is liver transplantation, which is impeded by the shortage of donor livers. Split liver transplantation (SLT) is important for addressing the donor liver shortage. However, full-right full-left SLT for two adult recipients is globally rarely conducted. This study aimed to investigate the clinical outcomes of this technique. Methods: We retrospectively analyzed the clinical data of 22 recipients who underwent full-right full-left SLT at Shulan (Hangzhou) Hospital between January, 2021 and September, 2022. The graft-to-recipient weight ratio (GRWR), cold ischemia time, operation time, length of the anhepatic phase, intraoperative blood loss, and red blood cell transfusion amount were all analyzed. The differences in liver function recovery after transplantation were compared between the left and right hemiliver groups. The postoperative complications and prognosis of the recipients were also analyzed. Results: The livers of 11 donors were transplanted into 22 adult recipients. The GRWR ranged from 1.16–1.65%, the cold ischemia time was 282.86 ± 134.87 min, the operation time was 371.32 ± 75.36 min, the anhepatic phase lasted 60.73 ± 19.00 min, the intraoperative blood loss was 759.09 ± 316.84 mL, and the red blood cell transfusion amount was 695.45 ± 393.67 mL. No significant difference in the levels of liver function markers, total bilirubin, aspartate aminotransferase, or alanine aminotransferase between left and right hemiliver groups at 1, 3, 5, 7, 14, and 28 d postoperatively was observed (both p > 0.05). One recipient developed bile leakage 10 d after transplantation, which improved with endoscopic retrograde cholangiopancreatography-guided nasobiliary drainage and stent placement. Another developed portal vein thrombosis 12 d after transplantation and underwent portal vein thrombolytic therapy and stenting to restore portal vein blood flow. A color Doppler ultrasound performed 2 d after transplantation revealed hepatic artery thrombosis in one patient, and thrombolytic therapy was administered to restore hepatic artery blood flow. The liver function of other patients recovered quickly after transplantation. Conclusions: Full-right full-left SLT for two adult patients is an efficient way to increase the donor pool. It is safe and feasible with careful donor and recipient selection. Transplant hospitals with highly experienced surgeons in SLT are recommended to promote using full-right full-left SLT for two adult recipients.

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.

Case Report: Diagnosis and Treatment Esophageal Varices

Background: Esophageal varices are dilated submucosal veins that connect the portal and systemic circulations to the esophagus. It occurs because of portal hypertension (most caused by cirrhosis), portal blood flow resistance, and increased portal vein blood flow. Esophageal variceal bleeding has a higher morbidity and mortality rate than other upper gastrointestinal bleeding types. In cases of esophageal variceal bleeding, an endoscopic examination is required to make a diagnosis, assess varicose veins, and plan management based on the underlying disease. This case report reviews the diagnosis and management of the esophageal varices at ENT-KL department. Case Presentation: We present a case in which a 54-year-old woman presented to the emergency department of Cut Meutia Hospital with complaints of painful swallowing and a swollen neck. The patient has had this complaint for 5 years, and is getting worse by the day. A barium swallow examination revealed esophageal varices in one-third of the distal esophagus between the seventh and ninth thoracic vertebrae. Conclusion: The patient was diagnosed with esophageal varices and was treated several times before being transferred to a gastroenterology department.

Altered Right Portal and Umbilical Vein Doppler Parameters in Fetal Macrosomia Resulting from Pregestational andGestational Diabetic Mothers: A Prospective Case-Control Study

Objective: To evaluate the blood flow of the umbilical vein and right portal vein in macrosomic fetuses of diabetic mothers and investigate the effect of maternal insulin treatment on these blood flows. Material and Methods: This prospective case-control study was conducted between March 2019 and December 2019. Fetuses of the 49 pregestational and gestational diabetic mothers who had an abdominal circumference percentile above 97% were evaluated as macrosomic and formed the study group. The study group was divided into two subgroups: patients treated with insulin and those who did not. In the control group, 48 non-diabetic pregnant women with matched gestational weeks whose fetuses are at the 10-90% percentile were included. Time-averaged maximum blood velocity (TAMXV) values of the right portal vein and the free loop of the umbilical vein were measured. Results: The median right portal vein TAMXV value and umbilical vein TAMXV value were found to be significantly higher in diabetic pregnancies (16.25 cm/s, and 15.28 cm/s, respectively) than in the control group (12.76 cm/s, and 13.38 cm/s, respectively, p<0.001). Umbilical and right portal vein flows were similar in macrosomic fetuses of diabetic mothers who were treated with insulin or those who did not. While umbilical vein flow in macrosomic fetuses increased as the gestational age progressed (p=0.028), it was observed steadily in normally growing fetuses. Conclusion: The umbilical and right portal vein flows are higher in macrosomic fetuses of diabetic mothers than in appropriately grown fetuses. Maternal insulin treatment does not affect fetal umbilical vein and right portal vein blood flow in macrosomic fetuses.

Роль комплексной эхографии печени в ранней диагностике преэклампсии и HELLP-синдрома

Objective. To study the possibilities of comprehensive ultrasound imaging with pulsed wave mode and Doppler color flow mapping in evaluation of hepatic blood flow and its compensatory capabilities in pre-eclampsia (PE) of different severity. Patients and methods. Complex liver ultrasonography combined with Doppler assessment of arterial and venous blood flow was performed in 87 pregnant women at 28–40 weeks’ gestation. The study group comprised 59 women with PE of varying severity and 12 women with HELLP syndrome. The control group included 30 women with normal pregnancy. Results. Doppler assessment of blood flow in the hepatic artery and in the maternal-placental-fetal system arteries in patients with moderate and severe PE revealed similar changes, which were manifested by elevated vascular resistance in these vessels and correlated with the severity of PE. The maximum values of pulsatility index and resistance index in the hepatic artery were observed in patients with HELLP syndrome – 1.6 ± 0.11 and 0.74 ± 0.08, respectively. Qualitative and quantitative characteristics of blood flow in the portal vein in patients with moderate PE did not statistically differ from those in the control group, while patients with severe PE and HELLP syndrome showed statistically significant disturbances of portal vein blood flow manifested by an increase in portal vein diameter and a decrease in maximum linear velocity of blood flow in the portal vein. Changes in hepatic arterial blood flow were found in patients with moderate PE in the absence of clinical and laboratory manifestations of liver dysfunction. Already in the early stages of PE, a shift of hemodynamic indices toward an increase in peripheral vascular resistance was determined. The increase in hepatic artery vascular resistance was observed in parallel with the increase of similar indices in the uterine-placental-fetal blood flow. Disturbance of blood flow in the portal vein was determined only in patients with severe PE and HELLP syndrome. Conclusion. Vascular disorders of the liver can serve as an additional diagnostic method for early diagnosis of liver involvement in the pathological process, while the signs of portal vein blood flow disorders are a criterion of extremely severe PE course, prognostically unfavorable regarding HELLP syndrome development. Key words: resistance index, liver dysfunction, hepatic artery, pre-eclampsia, hepatic blood flow, pulsatility index, HELLP syndrome