ABSTRACT
Refractory ascites is frequently a manifestation of end stage liver disease, and is most often associated with a poor prognosis. The efficacy and complications of peritoneovenous shunt have given conflicting results. The use of Denver shunt as a line of therapy is expected to add a more preload to the heart in such patients. The aim of the present echocardiographic study is to evaluate such expected changes in cardiac function in those patients. Ten patients with tense, refractory ascites [age ranged 36-52 years] were carefully selected for Denver peritoneovenous shunt and followed up clinically, and echocardiographically in the period from January 1998 to January 2000. The left ventricular outflow tract diameter was found to be sign increased after shunt operation [P<0.05], reflecting a deleterious effect on left ventricular function. In addition the right ventricular diastolic diameter as well as the tricuspid valve excursion were sign increased [p < 0.05, < 0.01 respectively]. Moreover the right ventricular function showed a sign reduction in right ventricular pre-ejection period / right ventricular ejection time RVPEP / RVET [p<0.05], reflecting both increased tricuspid valve flow as well as pulmonary hypertension with de creased right ventricular systolic function. It could be concluded that the major hemodynamic changes in cirrhotic patients with refractory ascites early after Denver shunt consist of exaggeration of hyperkinetic state and a minor rise of pulmonary artery pressure. Therefore it may be recommended that a preoperative echocardiographic evaluation of both cardiac function and pulmonary artery pressure determination is mandatory in cirrhoticpatients with refractory ascites