Porto-Caval and Porto-Pulmonary Anastomoses in Laennec's Cirrhosis and in Heart Failure1

Abstract

Thoracic anastomoses of the portal venous system were studied by injection in the portal vein in 20 human cadavers, including 10 with cirrhosis of the liver and 6 with conjestive heart failure. In all cases of cirrhosis, thoracic porto-caval anastomoses were very prominent: the short gastric and coronary veins anastomosed with both the sub-mucosal esophageal and peri-esophageal venous plexi. Although the submucosal esophageal veins were generally varicose, they showed great variation in their extent above the cardia. The periesophageal plexus, on the other hand, was consistently dilated and anastomosed freely with mediastinal, pleuro-pericardial and azygos veins. In 4 cirrhotics the mediastinal venous plexus showed anastomoses with bronchial veins, and in 2 cases injected material was present in the pulmonary veins and in the left atrium. Similar venous pathways were demonstrated in 6 cases of heart failure and in 4 cases having neither cirrhosis nor heart failure, but they were generally less prominent and the pulmonary veins did not fill with mass.