Portal vein flow was recorded by color Doppler sonography in 31 patients with chronic heart failure and 18 control subjects. Compared with patients showing a forward flow (Group A), those with reversed portal vein flow (Group B) had higher prevalence of tricuspid regurgitation (75% vs. 43%), hepatic congestion (100% vs. 30%) and ascites (50% vs. 18%), and showed higher right atrial pressure (25.3 ± 3.01 mmHg vs. 11.8 ± 5.75 mmHg, p < 0.01). In controls, portal vein pulsatility ratio was 0.66 ± 0.08, in Group A it was 0.46 ± 0.28 ( p < 0.01), in Group B −0.60 ± 0.19 ( p < 0.01). Portal vein pulsatility ratio negatively correlated with right atrial pressure (r = −0.87; p < 0.01). In Group A, hepatic congestion, ascites and tricuspid regurgitation were associated with a higher portal vein pulsatility. This study indicates that portal vein pulsatility ratio reflects the level of impairment of the right heart.