Effect of intrahepatic veno-venous communications on the consistency of hepatic venous pressure gradient and portal vein pressure gradient / 中华普通外科杂志

Objective:By using balloon occlusive hepatic angiography in cirrhotic portal hypertension to evaluate contrast doses on the detection rate of intrahepatic venous-lateral branch shunt (HVVC), and the effect on hepatic venous pressure gradient (HVPG) and portal vein pressure gradient (PPG).Methods:From Jan 2018 to Jun 2021, 131 patients received transjugular intrahepatic portosystemic shunt (TIPS) at Beijing Shijitan Hospital.Results:A positive correlation between PVP and weged hepatic venous pressure (WHVP) ( r=0.241, P=0.001) was found when only by right hepatic vein approach. Ten ml of iodine contrast medium when compared to 5ml doses found more cases of intrahepatic venous-venous lateral branch shunt. The mean PPG of patients with HVVC was significantly higher than the mean of HVPG( P<0.05).The right hepatic vein was the only reliable vein by which WHVP was measured. Conclusions:Right hepatic vein manometry,adequate ballon occlusion and using 10ml of iodine contrast help get reliable WHVP and found HVVC; HVVC can affect the consistency of HVPG and PPG.

Experimental studies for noninvasive assessment of portal vein pressure based on contrast enhanced subharmonic sonographic imaging / 生物医学工程学杂志

Portal hypertension (PHT) is a common complication of liver cirrhosis, which could be measured by the means of portal vein pressure (PVP). However, there is no report about an effective and reliable way to achieve noninvasive assessment of PVP so far. In this study, firstly, we collected ultrasound images and echo signals of different ultrasound contrast agent (UCA) concentrations and different pressure ranges in a low-pressure environment based on an

Observational Cohort Study of Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Abstract: Introduction and aim. Hepatic encephalopathy (HE) is a common complication of transjugular intrahepatic portosystemic shunting (TIPS). It is associated with a reduced quality of life and poor prognosis. The aim of this study was to compare two groups of patients who did and did not develop overt HE after TIPS. We looked for differences between these groups before TIPS. Material and methods. A study of 895 patients was conducted based on a retrospective analysis of clinical data. Data was analyzed using Fisher’s exact test, χ2, Mann Whitney test, unpaired t-test and logistic regression. After the initial analyses, we have looked at a regression models for the factors associated with development of HE after TIPS. Results. 257 (37.9%) patients developed HE after TIPS. Patients’ age, pre-TIPS portal venous pressure, serum creatinine, aspartate transaminase, albumin, presence of diabetes mellitus and etiology of portal hypertension were statistically significantly associated with the occurrence of HE after TIPS (p < 0.01). However, only the age, pre-TIPS portal venous pressure, serum creatinine, presence of diabetes mellitus and etiology of portal hypertension contributed to the regression model. Patients age, serum creatinine, presence of diabetes mellitus and portal vein pressure formed the model describing development of HE after TIPS for a subgroup of patients with refractory ascites. Conclusion. We have identified, using a substantial sample, several factors associated with the development of HE after TIPS. This could be helpful in further research.

The correlation between spleen SWV and portal vein pressure: its application in evaluating the short-term effect of interventional therapy for Budd-Chiari syndrome / 介入放射学杂志

Objective To discuss the application of the correlation between spleen shear wave velocity (SWV) and portal vein pressure in evaluating short-term curative effect of interventional therapy for Budd-Chiari syndrome (BCS).Methods The clinical data of a total of 30 BCS patients,who were admitted to authors' hospital during the period from May 2016 to October 2016 to receive treatment,were collected.The hepatic venous pressure gradient (HVPG) was measured before as well as after percutaneous transluminal angioplasty in all patients.Spleen SWV,the velocity and internal diameter as well as the velocity-to-diameter ratio of portal vein were calculated,the results were statistically analyzed.Results Technical success was achieved in all 30 patients.The mean HVPG score was strikingly reduced from preoperative (13.70±4.55)mmHg to postoperative (3.20±1.94) mmHg (P＜0.05).The preoperative and postoperative difference in HVPG had a parallel relationship with the preoperative and 2-day postoperative difference in spleen SWV as well as with the preoperative and 2-day postoperative difference in velocity-to-diameter ratio (r=0.856,P＜0.0001 and r=0.741,P＜0.0001 respectively).Conclusion A significant correlation exists between the spleen SWV and HVPG,therefore,SWV can be used as an effective index to evaluate the short-term curative effect of interventional treatment for BCS.

Correlation between wedge hepatic vein pressure and portal vein pressure in 22 patients with liver cirrhosis / 中华消化杂志

Objective To explore the correlation between wedged hepatic vein pressure (WHVP) and directly measured portal vein pressure (PVP) and further analyze the correlation between hepatic venous pressure gradient (HVPG) and portal pressure gradient (PPG).Methods From December 2012 to April 2014,the related data including WHVP,free hepatic venous pressure (FHVP),inferior vena cava pressure (IVCP) and PVP of patients who received transjugular interahepatic portosystem stentshunt (TIPS) treatment were collected,and HVPG and PPG were calculated.The correlations between WHVP and PVP,between FHVP and IVCP,between HVPG and PPG were analyzed.Pearson's correlation analysis were performed for correlation analysis.Results Twenty two patients matched the criteria were enrolled during the December 2012 to April 2014.The mean pressures of PVP and WHVP were (28.07±4.43) mmHg (1 mmHg=0.133 kPa) and (26.22±5.91) mmHg,respectively.PVPand WHVP were positively correlated,the correlation coefficient of them was 0.431 (P=0.045) and slope was0.323.The mean pressures of FHVP and IVCP were (7.31±3.37) mmHg and (6.82±4.01) mmHg,respectively.FHVP and IVCP were positively correlated,the correlation coefficient of them was 0.845 (P＜0.01) and slope was 0.711.The mean pressures of PPG and HVPG was (21.02±3.76) mmHg and (18.90±4.86) mmHg,respectively.There was no correlation between PPG and HVPG,the correlation coefficient of them was 0.014 (P=0.951).Conclusions There is a good correlation between PVP and WHVP,and so is the correlation between FHVP and IVCP.However,there is no good correlation between HVPG and PPG in this study because of the effects of many factors.

Relevant factors of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis / 中华肝胆外科杂志

Objective To analyze the relevant factors of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis. Methods The clinical data of 226 patients with hypertension due to cirrhosis resulting from hepatitis receiving simple splenectomy or splenectomy and portal-azygous devascularization in our hospital from August 2000 to June 2007 were retrospectively analyzed. Effective results were found in 154 of the patients. The 154 cases were divided into the thrombosis group and non-thrombosis group. The relation of portal vein thrombosis to the descendent level of portal vein pressure after operation,the prothrombin ratio (PTR) and fibrinogen(FIB) before operation, platelet count before and 1, 7, 14 days after operation, diameter of main portal vein and bilirubin level before operation and blood loss in operation were determined by logistic regression analysis. Results Portal vein thrombosis occurred in 31 patients. Regression univariate analysis showed that portal vein thrombosis was related to the descendent level of portal vein pressure after operation but not to the PTR and FIB, platelet count, diameter of main portal vein, bilirubin level and blood loss. Multivariate analysis demonstrated the same results. Conclusion The descended level of portal vein pressure is an important factor in portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis.