Portal Vein Pressure Research Articles

Portal hypertension research activity: A bibliometric analysis

Purpose: Portal hypertension (PHT) is a clinical syndrome characterized by a portal vein pressure gradient exceeding 5 mm Hg. Portal hypertensive complications have high morbidity and mortality. The present study aimed to provide an overview of portal hypertension research, as well as investigate the publications and citations of countries, authors, and institutions, international cooperation, and the density of terms used, employ a bibliometric analysis method, and shed light on future research. 
 Materials and Methods: The search was performed on the Web of Science (WoS) on October 21, 2021. The term "Portal hypertension" was searched in the paper "title" section between 01.01.2001 and 31.12.2020. The software VOS viewer (Version 1.6.17), which shows the partnership mesh in bibliometric works, was used to analyze the data obtained. 
 Results: The most frequently used keyword was portal hypertension with 46.4%, followed by cirrhosis with 11.1% and liver cirrhosis with 7.4%. In our study, the most effective journals related to portal hypertension were the World Journal of Gastroenterology (86 articles, 1264 citations), the Journal of Hepatology (45 articles, 2781 citations), and Hepatology (44 articles, 3769 citations), and Gastroenterology had the highest average citation (117.8).
 Conclusion: The present study offers an alternative viewpoint on global research trends in portal hypertension between 2001 and 2020 and is the first bibliometric analysis of portal hypertension, an issue with an increasing publication trend. We believe that by providing comprehensive and structured information on portal hypertension, the study will assist researchers in identifying publication hotspots and gaps on the subject.

A success story of modified Sugiura technique surgery in a non-cirrhotic portal hypertension (NCPH)

Background: Non-cirrhotic portal hypertension refers to elevated portal vein pressure in the absence of liver cirrhosis. Surgery could be an effective procedure for patients with recurrent variceal bleeding who fail to respond to pharmacotherapy or endoscopic therapy. We report a success story of modified Sugiura technique in managing a patient with non-cirrhotic portal hypertension. Case presentation: A male, 24-year-old, complained of recurrent vomiting of dark red blood color for six months. Anemic conjunctiva and splenomegaly were discovered during a physical examination. Pancytopenia and normal hepatobiliary function were revealed in the laboratory examination. Ultrasonography of the abdomen demonstrates nonspecific splenomegaly. An abdominal computerized tomography scan revealed hepatosplenomegaly and pelvic fluid accumulations. Grade IV esophageal varices and mild portal hypertensive gastropathy were observed during endoscopic examination. Active bleeding still presented despite initiation of medical treatment and endoscopic ligation. Finally, a surgical procedure using the Sugiura technique was performed. The patient was recovered, no recurrent symptom of hematemesis was reported after one year of follow-up. Conclusion: Modified Sugiura technique is a useful treatment of choice in non-cirrhotic portal hypertension patients who failed to respond other medical treatments. However, comprehensive assessment is critical prior to choose this procedure.

Current diagnostics and treatment of portal hypertension

In industrial nations portal hypertension is mostly aconsequence of liver cirrhosis and is aprerequisite for complications, such as esophageal varices and ascites. The pathophysiology of portal hypertension is complex. It is defined as an increase in the hepatovenous pressure gradient to > 5 mm Hg, with complications to be expected at ≥ 10 mm Hg. Measurement of the pressure of the hepatic vein occlusion is the gold standard for estimating portal pressure but this is not very practical. Liver elastography, in particular, has proven to be an effective noninvasive tool to identify patients with clinically significant portal hypertension (CSPH). Current treatment concepts address the CSPH even before the onset of complications to reduce the likelihood of decompensation. In addition to beta blockers, a transjugular intrahepatic portosystemic shunt is the most important procedure to lower portal vein pressure and enables an improvement in the prognosis of selected patients.

S1836 Six Years of Evolution With Portal Cavernomatosis and Portal Biliopathy

Introduction: In patients with Portal Biliopathy (PB), It is paramount to engage several branches of gastroenterology to interject the aggressive evolution of this condition. Case Description/Methods: Our patient is a Man of 45 years old. Medical history of pancreatic divisum, chronic pancreatitis, biliary litho extraction, cholecystectomy, use of endoprosthesis, and pancreatic conduct stenosis. On CT scans in February 2015 he presented a pancreatitis Baltazar E, generating a perfusion defect, and multiple collaterals, in Abril 2015 portal cavernomatosis, and by January 2018 the collateral veins provoked biliary ectasis. During the next 2 years, he presented two events of mild cholangitis. To solve the choledochal impingement, on October 8, 2019, it took place a portal vein angioplasty with a balloon. The direct extrahepatic portal vein pressure was 30 mmHg pre-plasty, diminishing to 22 mmHg post-plasty. Posterior to the intervention, he had a new severe healthcare-associated colangitis plus acute pancreatitis, with a 7 mm dilatation only in the intrahepatic biliary pathway. To improve the biliary stasis, by CPRE it was placed a metallic stent covered with a Wallflex 10 mm x 8 cm. By February 2020, a CT scan still showed a permeable porta in the confluence, yet the portal prosthesis was not visible. Finally in September 2021, without clinic traits of portal hypertension, events of cholestasis, and improvement in hepatic function. (Figure) Discussion: In the biliary tract, venous drainage passes through two venous plexus named, the epicholedochal venous plexus of Saint and the paracholedochal venous plexus of Petren. In portal biliopathy, changes are a result of dilatation of veins of the plexus of Saint, causing bile duct impingement. It has been hypothesized that this lead to fibrous scarring of porta hepatis, and ischemic injury to the bile ducts resulting in stricture formation and caliber irregularity with upstream dilatation. Several studies have shown that bile duct changes occur in 81–100% of patients with extrahepatic portal vein obstruction, but only 5–30% of patients present symptoms of biliary obstruction. In adults conditions such as thrombophilia, intra-abdominal infection, malignancy, myeloproliferative disorders and cirrhosis have been implicated PB is mainly a feature of extrahepatic portal venous obstruction, patients presenting with symptoms require an integrated management addressing biliary obstruction and portal hypertension in tandem. However, the relief of both conditions is only temporary.Figure 1.: Top. Initial axial CT scan following the known event of acute pancreatitis, showing acute splenic-portal venous thrombosis demonstrated by unenhanced and distended portal vein (yellow arrow in a). The middle image three months later shows the formation of small collateral vessels in the hepatic hilium, (yellow arrow in b), and also notes new-onset ascites due to impaired liver function. Coronal reformat image two years later, points to the focal area of chronic portal thrombosis, yellow arrow in (c) with more prominent appearance collateral vessels “cavernomatosis” (asterisk), several perfusion defects in the liver parenchyma, and marked splenomegaly. Middle. DSA images, in (a) transhepatic percutaneous venography with opacification of intrahepatic portal vasculature with a sudden interruption in the site of thrombosis (yellow arrow in a). (b) splenic approach with opacification of the extrahepatic portal vein and aneurismatic collateral vessels due to cavernomatosis and upstream thrombotic interruption (yellow arrow in b). (c) final imagen after portal vein angioplasty demonstrates adequate and complete opacification of the portal vein and its branches. Bottom. ERCP in (a) shows intrahepatic bile duct dilatation and impingement and (b) after stent placement with diminished dilatation.

S3143 Rare Case of Plasma Cell Infiltration-Induced Cirrhosis

Introduction: Multiple myeloma (MM) is a type of malignancy that arises from the unorganized replication of plasma cells within the bone marrow. The overproduction of these cells damages systems throughout the body leading to early asymptomatic symptoms that can rapidly progress to systemic signs of disease. Liver involvement with MM is less common and generally occurs through plasma cell infiltration, light chain/amyloid deposition, and biliary obstruction. Though it can occur, the probability of it presenting near the time of diagnosis of MM is very rare and associated with poorer outcomes. Case Description/Methods: A 59-year-old male presented with generalized weakness, shortness of breath and weight gain. Physical exam showed sign of ascites and hepatomegaly. PMH was significant for esophageal cancer and a recent diagnosis of MM. No history of acute or chronic liver disease or cirrhosis risk factors. CT scan showed cardiomegaly, bilateral pleural effusions, pulmonary edema, and cirrhosis with abdominal ascites. Labs was unremarkable other than normocytic anemia. An echocardiogram showed mild reduced ejection fraction (47%) with speckle tracking suggestive of cardiac amyloidosis. Abdominal ultrasound confirmed appearance of cirrhosis, ascites, and right pleural effusion. Cirrhosis work up revealed negative hepatitis panel, normal alpha-1 antitrypsin, and normal ceruloplasmin. EGD was performed and ruled out extracellular vesicles (EV) but noted type I isolated gastric varices. Liver biopsy confirmed cirrhosis and showed portal tract damage with severe extensive plasma cell infiltration. Additionally, fragments of hepatic parenchymal showed disrupted lobular architecture by septal fibrosis and nodular formation. Immunohistochemistry was positive for CD3, CD20, CD5, BCL2, CD79a, and CD138 as well as increased lambda light chain compared to free kappa light chain. Despite extensive treatment including repeated thoracentesis and paracentesis, patient eventually developed in to decompensating liver cirrhosis (Figure 1). Discussion: In previous studies, plasma cell infiltration of the liver was seen in about 40% of cases of MM, but rarely lead to cirrhosis. This case is unique in that the patient had liver failure caused by cirrhosis and that it was some of the presenting symptoms. Whether due to masked signs or aggressive onset, the outcome for this diagnosis is poor and more specific factors observing liver function could have provided a more favorable outcome.Figure 1.: Cirrhosis secondary to plasma cell infiltration. Table 1. - Total Protein 5.0 g/dL Serum Ascites Albumin Gradient (SAAG) 1.9 g/dL Left Hepatic Vein Pressure 25 Hg Left Portal Vein Pressure 29 Hg Portosystemic Pressure Gradient 5 Hg EUS Guided Shear Wave Elastography of Liver 27 kPa

312.8: What Is the Risk Factor of Graft Mortality in Patients Who Underwent Simultaneous Splenectomy During Living Donor Liver Transplantation?

Introduction: Splenectomy is performed in living donor liver transplantation (LDLT) for portal flow modulation. The aim of this study was to identify the risk factor of 6-month graft mortality in patients who underwent splenectomy in LDLT. Methods: Data from 441 adult patients who underwent simultaneous splenectomy during primary LDLT were collected retrospectively. Risk factors of 6-month graft mortality were investigated. Results: Mean recipient age was 55 years. Mean donor age was 38.7 years. Two hundred and five patients (46.5%) received left lobe graft. Mean graft weight (GW)-standard liver weight ratio was 41.5% and GW-recipient weight ratio was 0.79%. Six-month graft survival rate after LDLT in 441 patients was 93.8%, which was significantly better compared to patients without simultaneous splenectomy or splenic artery ligation (83.9%, p<0.0001). Univariate analysis revealed the following risk factors for 6-month graft mortality in patients with splenectomy: neutrophil-lymphocyte ratio > 4, acute liver failure, hospitalized before LDLT, donor > 60 years of age, MELD score > 22, pre-LDLT platelet < 40, 000/mm3, portal vein pressure when LDLT finished (PVP) > 20 mmHg. Multivariate analysis identified that donor > 60 years of age (Hazard ratio=4.50, p=0.049), pre-LDLT platelet < 40, 000/mm3 (Hazard ratio=2.58, p=0.03), and PVP > 20 mmHg (Hazard ratio=7.46, p<0.001) were the independent risk factors of 6-month graft mortality after LDLT.Conclusion: Splenectomy in LDLT improves survival rate after LDLT. Careful attention is needed for patients with platelet < 40, 000/mm3, PVP > 20 mmHg, and received graft from donor > 60 years of age.

Characterization of the mesenteric circulatory physiology during hemorrhagic shock in a swine model

This study aimed to characterize blood flow through the mesenteric circulation during hemorrhage and resuscitation in a large animal model. Five male swine (50-70 kg) underwent anesthesia and placement of flow probes and pressure catheters around and within the superior mesenteric artery, portal vein, and inferior vena cava. A laser doppler flow probe was placed on the intestine to measure end-organ perfusion. Animals were then exsanguinated to a systolic blood pressure of <50mmHg with 60-minutes of shock followed by resuscitation for 120-minutes. Animals were placed into hemorrhagic shock (lactate peak 5.9 ± 2.1 mmol/L vs baseline: 3.4 ± 0.7 mmol/L) with lower pressures and flows during shock and restoration to baseline following resuscitation: SMA (70 vs 36 vs 75 mmHg, p<0.001; 856 vs 371 vs 762 mL/min, p<0.001), portal vein (9 vs 8 vs 10mmHg, p<0.001; 200 vs 52 vs 141 mL/min, p<0.001), IVC (12 vs 7 vs 10 mmHg, p<0.001; 209 vs 27 vs 163 mL/min, p<0.001), and mean arterial pressure (MAP) (67 vs 36 vs 69 mmHg, p<0.001). LDF fell during hemorrhage (1.38 vs 0.38 blood perfusion units (BPU), p<0.001) and did not return to baseline during resuscitation (0.70 BPU, p<0.001). The intestine achieved only 51% of baseline LDF perfusion after resuscitation despite return of mesenteric hemodynamics. Despite macrovascular physiologic restoration after hemorrhagic shock, end organ perfusion did not adequately recover following resuscitation to baseline MAP. Continuous physiologic insult to the mesentery is likely ongoing after systemic hemodynamic restoration.

Study on the correlation between PPG and HVPG in patients with portal hypertension

Objective: To explore the correlation between portal vein pressure gradient (PPG) and hepatic vein pressure gradient (HVPG) in patients with portal hypertension (PHT). Methods: 752 cases with portal hypertension (PHT) who underwent transjugular intrahepatic portosystemic shunt (TIPS) and met the enrollment criteria between January 2016 to December 2019 were analyzed for hepatic vein, inferior vena cava and portal vein pressure. Paired t-test was used for analysis. Pearson correlation test was used to estimate correlation coefficient and coefficient of determination. P<0.05 were considered statistically significant. Results: Wedged hepatic vein pressure (WHVP), portal vein pressure (PVP), correlation coefficient, and coefficient of determination were 27.98±8.95 mmHg, 33.85±7.33 mmHg, 0.329 (P<0.001), and 0.108, respectively. HVPG, PPG,correlation coefficient, and coefficient of determination were 16.84±7.97 mmHg, 25.11±6.95 mmHg (P<0.001), 0.145, and 0.021 (P<0.001), respectively. The difference between HVPG and PPG was greater than 5 mmHg in 524 cases, accounting for 69.7%. The difference between HVPG and PPG was within 5 mmHg or basically equal in 228 cases, accounting for 30.3%. The correlation coefficient between free hepatic venous pressure (FHVP) and inferior vena cava pressure (IVCP) was 0.568 (P<0.001), and the coefficient of determination was 0.323. According to the presence or absence of hepatic venous collaterals after balloon occluded hepatic angiography, they were divided into two groups: 157 (20.9%) cases in the group with hepatic venous collaterals, and 595 (79.1%) cases in the group without hepatic venous collaterals. The parameters of the two groups were compared: WHVP (15.73±3.63) mmHg vs. (31.22±6.90) mmHg, P<0.001; PVP (31.69±8.70) mmHg vs. (34.42±6.81) mmHg, P<0.001; HVPG (7.18±4.40) mmHg vs. (19.40±6.62) mmHg, P<0.001; PPG (24.24±8.11) mmHg vs. (25.34±6.60) mmHg, P<0.001; free hepatic venous pressure (FHVP) (8.58±3.37) mmHg vs. (11.82±5.07) mmHg , P<0.001; inferior vena cava pressure (IVCP) (7.45±3.29) mmHg vs. (9.09±4.14) mmHg, P<0.001. Conclusion: The overall correlation is poor between HVPG and PPG. HVPG of most patients is not an accurate representation of PPG, and the former is lower than the latter. Hepatic venous collateral formation is one of the important reasons for the serious underestimation of HVPG values.

Analysis of the necessity of anticoagulation therapy and influencing factors of stent occlusion after transjugular intrahepatic portosystemic shunt

Objective: To explore the necessity of anticoagulation therapy and influencing factors of stent occlusion after transjugular intrahepatic portosystemic shunt. Methods: The basic information, laboratory test results, preoperative portal venous pressure, postoperative anticoagulation time, postoperative stent stenosis or occlusion, followed-up and other data of all patients who underwent TIPS surgery in Shandong Provincial Hospital from 2010 to 2019 were retrospectively analyzed. Data were analyzed using t-test, χ2 test, and multivariate analysis (logistic regression and Cox-regression-analysis). Results: A total of 280 cases were finally included in the study, of which 110 (39.3%) had stent stenosis or occlusion, and 170 (60.7%) had stent patency. New or worsening ascites were identified in 194 cases during the follow-up period, including 14 (31.1%) cases in the stent stenosis or occlusion group and 19 (12.8%) cases in the stent patency group. Univariate analysis showed that presence or absence of platelet (P=0.037) and total bilirubin (P=0.038) were correlated with stent stenosis or occlusion. Postoperative continuous anticoagulation was correlated with stent blockage (P=0.029) in patients with partial portal vein thrombosis. Postoperative continuous anticoagulation and stent occlusions were not significantly correlated in patients with preoperative portal cavernoma and preoperative portal vein patency (P=0.848; P=0.744). Multivariate analysis results showed that whether long-term anticoagulation (P=0.017), all-cause rebleeding (P<0.001), postoperative significant hepatic encephalopathy (P<0.012), and postoperative new or worsening ascites (P<0.001) was significantly associated with stent occlusion (P<0.05), while platelets (P=0.134), total bilirubin (P=0.229), international normalized ratio (P=0.436), and portal vein pressure (P=0.230) were not significantly associated with stent occlusion after surgery. Conclusion: In patients with partial portal vein thrombosis before surgery, continuous anticoagulation for 30 days post-TIPS therapy can effectively prevent stent stenosis or occlusion; while in patients with portal vein patency, portal cavernoma and complete portal vein blockage before surgery, postoperative anticoagulation has no significant effect on stent stenosis or occlusion.

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.

Transjugular intrahepatic portosystemic shunt with radioactive seed strand for main portal vein tumor thrombosis with cirrhotic portal hypertension.

BACKGROUNDPatients with hepatocellular carcinoma complicated with main portal vein tumor thrombosis (mPVTT) and cirrhotic portal hypertension (CPH) have an extremely poor prognosis, and there is a lack of a clinically effective treatment paradigm.AIMTo evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) combined with radioactive seed strand for the treatment of mPVTT patients with CPH.METHODSThe clinical data of 83 consecutive patients who underwent TIPS combined with 125I seed strand placement for mPVTT and CPH from January 2015 to December 2018 were retrospectively reviewed. Procedure-related data (success rate, relief of portal vein pressure and CPH symptoms, and adverse events), PVTT response, and patient survival were assessed through a 2-year follow-up.RESULTSThe success rate was 100.0% without perioperative death or procedure-related severe adverse events. The mean portal vein pressure was significantly decreased after the procedure (22.25 ± 7.33 mmHg vs 35.12 ± 7.94 mmHg, t = 20.61, P < 0.001). The symptoms of CPH were all effectively relieved within 1 mo. The objective response rate of PVTT was 67.5%. During a mean follow-up of 14.5 ± 9.4 mo (range 1-37 mo), the cumulative survival rates at 6, 12 and 24 mo were 83.1%, 49.7%, and 21.8%, respectively. The median survival time was 12.0 ± 1.3 mo (95% confidence interval: 9.5-14.5). In multivariate Cox regression analysis, body mass index, Child-Pugh grade, cTNM stage, and PVTT response were independent prognostic factors (P < 0.05).CONCLUSIONTIPS combined with radioactive seed strand might be effective and safe in treating mPVTT patients with CPH.

Safety and efficacy of TIPS combined with iodine-125 seed strands in the treatment of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis

Objective: To study the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with iodine-125 (125Ⅰ) seed strands implantation in patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. Methods: 25 cases with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ requiring TIPS were simultaneously implanted with 125Ⅰseed strand. Tumor thrombus was controlled with 125I seed implantation brachytherapy to keep the TIPS pathway unobstructed, reduce the portal vein pressure, and observe the changes in the cause of death of the patients. During the same period, 30 cases without TIPS and seed strand implantation were used as controls. Data between groups were compared using t-test, Chi-Squared test or Fisher's exact test. Results: TIPS combined with 125Ⅰ seed strand implantation was safe in patients with diffuse hepatocellular carcinoma combined with type III/IV portal vein tumor thrombus, and 92.0% (23/25) of the patients maintained unobstructed TIPS pathway. Compared with the control group, patients in the treatment group died of fewer lead-related complications, and most died from chronic liver failure (84.0% vs. 56.7%, χ2 = 4.771, P=0.029). The incidence of upper gastrointestinal bleeding was significantly decreased (12.0% vs. 46.7%, χ2 =7.674, P=0.006) and ascites severity was significantly improved (mild 40.0% vs. 16.7%, moderate 52.0% vs. 20.0%, severe 8.0% vs. 46.7%, χ2 =13.246 , P=0.001). Conclusions: TIPS combined with 125Ⅰ seed strand implantation is safe and feasible in patients with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ. Moreover, it can effectively keep the shunt patency and reduce portal vein pressure, thereby reducing the incidence of upper gastrointestinal bleeding and improving the degree of ascites. TIPS combined with 125Ⅰ seed strand implantation may be used as a standard treatment modality for patients requiring TIPS therapy combined with tumor thrombus type Ⅲ/Ⅳ.

Image Features of Dynamic Enhanced Computed Tomography Scanning Combined with Digestive Endoscopy in the Treatment of Gastroesophageal Varices and Nursing of Esophagogastric Gastric Varices Bleeding.

The objective of this study was to investigate the application of dynamic contrast-enhanced CT images in the nursing of patients with gastroesophageal varices (GOV) treated by digestive endoscopy and its role in relieving bleeding symptoms. A total of 60 patients with liver cirrhosis and GOV were selected as the research objects. According to whether CT was used to evaluate the position of tissue adhesion embolism, the patients were divided into the control group (24 cases) and the observation group (36 cases). The treatment effect and bleeding situation of patients in the two groups were analyzed and compared. The results showed that the main portal vein pressure (17.24 ± 1.02 cmH2O), liver function recovery effect (2.84 ± 0.45 points), and total effective rate (100%) in observation group were better than those in control group (9.70 ± 1.22 cmH2O, 0.95 ± 0.72 points, and 79.17%, respectively) (P < 0.05). In addition, the bleeding rate in observation group (0%) was significantly lower than that in control group (16.67%) (P < 0.05). In conclusion, dynamically enhanced CT scan images combined with digestive endoscopy can help improve the therapeutic effect of GOV and reduce postoperative bleeding, which was worthy of clinical application and promotion.

Small-for-Size Syndrome: Systemic Review in a Porcine Experimental Model

The small-for-size syndrome (SFSS) is characterized by prolonged hyperbilirubinemia, coagulopathy, and/or encephalopathy caused by a small liver graft that cannot sustain the metabolic demands of the recipient after a partial liver transplant (PLT). Models of PLT in pigs are excellent for studying this syndrome. This review aimed to identify the different porcine models of SFSS in the literature and compare their technical aspects and therapeutics methods focused on portal inflow modulation (PIM). We performed a systematic review of the porcine experimental model and SFSS. The MEDLINE-PubMed, EMBASE, Cochrane Library, LILACS, and SciELO databases were electronically searched and updated until June 20, 2021. The MeSH terms used were ''ORGAN SIZE'' AND ''LIVER TRANSPLANTATION". Thirteen SFSS porcine models were reported. Four were performed with portocaval shunt to PIM and 3 with mesocaval shunt to PIM. A few studies focused on clinical therapeutics to PIM; a study described somatostatin infusion to avoid SFSS. Initially, studies on PIM showed its potentially beneficial effects without mentioning the minimum portal flow that permits liver regeneration. However, an excessive portal diversion could be detrimental to this process. The use of porcine models on SFSS resulted in a better understanding of its pathophysiology and led to the establishment of various types of portal modulation, surgical techniques with different complexities, and pharmaceutical strategies such as somatostatin, making clear that without reducing the portal vein pressure the outcomes are poor. With the improvement of these techniques, SFSS can be avoided.

Correlation of pressure gradient in three hepatic veins with portal pressure gradient.

BACKGROUNDThe liver is one of the most important organs in the human body, with functions such as detoxification, digestion, and blood coagulation. In terms of vascular anatomy, the liver is divided into the left and the right liver by the main portal vein, and there are three hepatic efferent veins (right, middle, and left) and two portal branches. Patients with impaired liver function have increased intrahepatic vascular resistance and splanchnic vasodilation, which may lead to an increase in the portal pressure gradient (PPG) and cause portal hypertension (PHT). In order to measure the increased pressure gradient of portal vein, the hepatic venous pressure gradient (HVPG) can be measured to reflect it in clinical practice. The accuracy of PPG measurements is directly related to patient prognosis.AIMTo analyze the correlation between HVPG of three hepatic veins and PPG in patients with PHT.METHODSFrom January 2017 to December 2019, 102 patients with PHT who met the inclusion criteria were evaluated during the transjugular intrahepatic portosystemic shunt procedure and analyzed.RESULTSThe mean HVPG of the middle hepatic vein was 17.47 ± 10.25 mmHg, and the mean HVPG of the right and left hepatic veins was 16.34 ± 7.60 and 16.52 ± 8.15 mmHg, respectively. The average PPG was 26.03 ± 9.24 mmHg. The correlation coefficient and coefficient of determination of the right hepatic vein, middle hepatic vein, and left hepatic vein were 0.15 and 0.02 (P = 0.164); 0.25 and 0.05 (P = 0.013); and 0.14 and 0.02 (P = 0.013), respectively. The mean wedged hepatic vein/venous pressure (WHVP) of the middle and left hepatic veins was similar at 29.71 ± 12.48 and 29.1 ± 10.91 mmHg, respectively, and the mean WHVP of the right hepatic vein was slightly lower at 28.01 ± 8.95 mmHg. The mean portal vein pressure was 34.11 ± 8.56 mmHg. The correlation coefficient and coefficient of determination of the right hepatic vein, middle hepatic vein, and left hepatic vein were 0.26 and 0.07 (P = 0.009); 0.38 and 0.15 (P < 0.001); and 0.26 and 0.07 (P = 0.008), respectively. The average free hepatic venous pressure (FHVP) of the right hepatic vein was lowest at 11.67 ± 5.34 mmHg, and the average FHVP of the middle and left hepatic veins was slightly higher at 12.19 ± 4.88 and 11.67 ± 5.34 mmHg, respectively. The average inferior vena cava pressure was 8.27 ± 4.04 mmHg. The correlation coefficient and coefficient of determination of the right hepatic vein, middle hepatic vein, and left hepatic vein were 0.30 and 0.09 (P = 0.002); 0.18 and 0.03 (P = 0.078); and 0.16 and 0.03 (P = 0.111), respectively.CONCLUSIONMeasurement of the middle hepatic vein HVPG could better represent PPG. Considering the high success rate of clinical measurement of the right hepatic vein, it can be the second choice.

Pentadecapeptide BPC 157 Counteracts Hemodynamic and ECG Disturbances Induced by Sotalol in Rats

Cytoprotective and organoprotective pentadecapeptide BPC 157 demonstrated particular beneficial cardiovascular effects (Curr Pharm Des. 2014;20(7):1121‐1125). Antiarrhythmic effects counteracted digoxin toxicity (Regul Pept. 2009;156(1‐3):83‐89), major blood vessel occlusions (Biomedicines 2021, 9,1029; 2021, 9,609; 2021, 9, 792) and lidocaine toxicity (Emerg Med Int. 2020;2020:6805354). Now, we reveal, by BPC 157, mitigation of hemodynamic and ECG disturbances of sotalol, a class III antiarrhythmic with non‐selective beta‐blocking activity.Albino Wistar rats received sotalol (80mg/kg, intragastrically), and at 5 min thereafter were treated with saline or BPC 157 (10ng/kg, intragastrically. Seven standard and one precordial ECG leads were recorded (baseline; after application of sotalol; and 10, 30, 90, 120 and 150 minutes after application of sotalol). Heart rate, QRS complex, PR and QT intervals were analyzed. Corrected QT intervals (QTc) were calculated according to Fridericia formula.Baseline ECG readings included average heart rate of 275.5 ± 25 bpm, average PR 54.8 ± 3.4 ms, average QRS complex 25.0 ± 4.23 ms and average QTc 166 ± 9.7 ms. Sotalol caused bradycardia (245 ± 23.5 bpm), PR prolongation (57.3 ± 2.7 ms), QRS widening (26.3 ± 3.2 ms), and QTc prolongation (173 ± 9.1 ms), measured 10 minutes after application. In BPC 157 treated animals (5 minutes after BPC‐157 application, 10 minutes after sotalol application), these effects were attenuated (heart rate 306 ± 31.7 bpm, average PR 52.3 ± 1.6 ms, average QRS 23.7 ± 5.4 ms and average QTc 159 ± 21.2 ms). This attenuation was lost in later measurements, for QRS ‐ 25 minutes after BPC 157 application, for frequency after 55 minutes, for PR after 115 minutes and for QTc after 145 minutes. In animals treated with sotalol, an increase in superior sagittal sinus pressure (10 ± 5 mmHg), as well as an increase in portal vein (17 ± 4 mmHg) and inferior caval vein pressures (12 ± 6 mmHg) were noted, along with the decrease in abdominal aortic pressure (53 ± 10 mmHg). These effects were attenuated in BPC treated animals (‐1 ± 1 mmHg for superior sagittal sinus, 7 ± 1 mmHg in portal vein, 5 ± 1 mmHg in inferior caval vein, and 81 ± 7 mmHg in abdominal aorta).In conclusion, BPC 157 attenuated deleterious hemodynamic effects of sotalol while the effects on the ECG parameters were also noted, although not long lasting, supporting the view of BPC‐157 as a rapid‐acting protective agent.

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.

Computed Tomography-Based Texture Features for the Risk Stratification of Portal Hypertension and Prediction of Survival in Patients With Cirrhosis: A Preliminary Study.

ObjectiveClinical evidence suggests that the risk stratification of portal hypertension (PH) plays a vital role in disease progression and patient outcomes. However, the gold standard for stratifying PH [portal vein pressure (PVP) measurement] is invasive and therefore not suitable for routine clinical practice. This study is aimed to stratify PH and predict patient outcomes using liver or spleen texture features based on computed tomography (CT) images non-invasively.MethodsA total of 114 patients with PH were included in this retrospective study and divided into high-risk PH (PVP ≥ 20 mm Hg, n = 57) or low-risk PH (PVP < 20 mm Hg, n = 57), a progression-free survival (PFS) group (n = 14), or a non-PFS group (n = 51) based on patients with rebleeding or death after the transjugular intrahepatic portosystemic shunt (TIPS) procedure. All patients underwent contrast-enhanced CT, and the laboratory data were recorded. Texture features of the liver or spleen were obtained by a manual drawing of the region of interest (ROI) and were performed in the portal venous phase. Logistic regression analysis was applied to select the significant features related to high-risk PH, and PFS-related features were determined by the Cox proportional hazards model and Kaplan-Meier analysis. Receiver operating characteristic (ROC) curves were used to test the diagnostic capacity of each feature.ResultsFive texture features (one first-order feature from the liver and four wavelet features from the spleen) and the international normalized ratio (INR) were identified as statistically significant for stratifying PH (p < 0.05). The best performance was achieved by the spleen-derived feature of wavelet.LLH_ngtdm_Busyness, with an AUC of 0.72. The only log.sigma.3.0.mm.3D_firstorder_RobustMeanAbsoluteDeviation feature from the liver was associated with PFS with a C-index of 0.72 (95% CI 0.566–0.885), which could stratify patients with PH into high- or low-risk groups. The 1-, 2-, and 3-year survival probabilities were 66.7, 50, and 33.3% for the high-risk group and 93.2, 91.5, and 84.4% for the low-risk group, respectively (p < 0.05).ConclusionCT-based texture features from the liver or spleen may have the potential to stratify PH and predict patient survival.

Intrahepatic Portosystemic Shunt In Cardiac Amyloidosis: Turning Off The Faucet Leads To Resolution Of Hepatic Encephalopathy And Improvement In Heart Failure Symptoms

<h3>Introduction</h3> Spontaneous portosystemic shunts (SPSS) are extremely rare and usually extrahepatic due to portal hypertension in the setting of cirrhosis. Current knowledge regarding SPSS in adults in the absence of cirrhosis is limited. The implications of SPSS in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) are unknown. <h3>Case</h3> A 76-year-old man with a history of HTN, CAD and systolic dysfunction (EF 45%) presented to the hospital with symptoms of HF exacerbation and cognitive dysfunction. Initial cardiac labs were notable for a borderline elevated troponin and high natriuretic peptic level. Hepatic labs were notable for mild elevation in transaminases, thrombocytopenia and an elevated ammonia level. Transthoracic echocardiogram (TTE) revealed that the EF was stable at 45%, but there was biatrial enlargement and progression of concentric LVH to 1.8cm and resultant small LV cavity (EDV index 39ml/m²), suspicious for infiltrative cardiomyopathy (Fig A). SPEP/UPEP with immunofixation and serum free light chains were normal and Tc-99m PYP study was consistent with ATTR-CM (Fig B). Abdominal US revealed a large intrahepatic venous shunt from the right portal vein to the right hepatic vein. Right heart catheterization, portal venogram and liver biopsy revealed a right atrial pressure of 14mmHg, cardiac output of 6.2L/min, normal pulmonary vascular resistance, hepatic vein pressure of 14mmHg, portal vein pressure of 15mmHg, confirmation of the large SPSS (Fig C) and no evidence of cirrhosis. The patient underwent embolization of the SPSS with a 22mm vascular plug (Fig D). Following closure, the patient's HF symptoms and HE improved dramatically and his abnormal hepatic labs normalized. He was started on a stabilizer for the treatment of his ATTR-CM. At one year, he has not had recurrent symptoms of HE, nor repeat hospitalization for HF exacerbation. <h3>Discussion</h3> This patient most likely had a SPSS that only manifested clinically in the setting of elevated right atrial and hepatic pressures due to the development of ATTR-CM. Ultimately, the decision was made to close the SPSS for two reasons. The first was to treat HE—in the same way that transjugular intrahepatic portosystemic shunt (TIPS) procedure can cause HE and subsequent TIPS closure can be an effective treatment for refractory HE. The second was to improve HF symptoms. Although this patient's cardiac output was "normal", it was likely actually high in the context of the severe LVH and small LV cavity due to ATTR-CM and the increased venous return was poorly tolerated given the underlying restrictive cardiomyopathy.

Evaluation of spleen stiffness in healthy population: a vibration-controlled transient elastography study

Aim: Vibration-controlled transient elastography (VCTE) is an accurate technique that has an increasing use. In recent years, VCTE was started to use in predicting spleen stiffness (SS). Portal vein pressure and flow have an impact on SS and in previous studies it was used to predict portal hypertension, esophageal varices. In this study, our aim was to evaluate the SS measurements in healthy population and its correlation with age, sex, liver stiffness measurement (LSM), continued attenuation parameter (CAP) and body mass index (BMI).&#x0D; Material and Method: We enrolled healthy volunteers who were agreed to participate to the study and collected age, sex, smoking history, alcohol consumption, body mass index before the VCTE procedure. Liver and spleen elastography were performed to all patients by VCTE.&#x0D; Results: A total of 97 participants were enrolled to the study, 15 patients were excluded and 82 patients included for the final analysis. There was no significant difference in SS, liver stiffness measurement LSM, CAP and BMI between females and males. There was no correlation between age and SS. There was a weak correlation between SS and LSM, SS and CAP and no correlation was found between SS and BMI.&#x0D; Conclusions: SS had a weak correlation with LSM and CAP but not with BMI, age and sex. There is no extra-large probe use in SS measurement and it was a challenge in participants with increased submucosal fat thickness. Multiple and repeatable studies needed to set an accurate cut-off point and evaluate the factors that impact on SS in healthy individuals.