THE EFFECT OF A SIDE-TO-SIDE PORTACAVAL SHUNT ON HEPATIC HEMODYNAMICS IN CIRRHOSIS*

Abstract

Measurements of hepatic blood flow (HBF), wedged hepatic vein pressure (WHVP), post-sinusoidal vascular resistance (HR), and splanchnic oxygen consumption (SOC) were made by hepatic vein catheterization in 9 cirrhotic patients before and after side-to-side portacaval shunt. HBF dropped in each patient (average fall 59%), as did WHVP (average fall 55%). HR did not change significantly. SOC fell 37% on the average although arterial-hepatic vein oxygen difference increased in all patients. HBF fell to a degree greater than that previously noted after end-to-side portacaval shunt (59% as compared to 45%). The statistical significance of this difference is questionable (p< 0.06). If there actually is a greater fall in HBF after side-to-side shunt, it can be accounted for by retrograde flow of hepatic arterial blood through the proximal portal vein and the portal vena caval anastomosis. In spite of the marked fall in HBF and the apparent drop in SOC after side-to-side shunt, the clinical results were not demonstrably different from those after end-to-side shunt.