flow, found an average fall of 22 per cent in five patients after this operation (4). Hepatic oxygen consumption did not appear to be decreased. Nardi, using a less widely accepted technique for liver blood flow determination (the disappearance rate of radioactive colloidal chromic phosphate), noted a fall in six of nine patients after splenorenal shunt (5). The mean change in the nine patients was a fall of 24 per cent.In the end-to-side portacaval shunt, the portal vein is ligated and divided, and its distal end is implanted into the vena cava. Diversion of portal blood from the liver is therefore complete, and hepatic hemodynamic changes would be expected to be even greater than after a splenorenal shunt. Published studies on hemodynamic changes are limited to three cases included in the report of Bradley, Smythe, Fitzpatrick, and Blakemore (4), and in these three, hepatic blood flow fell an average of 36 per cent. In the clinic from which our patients are drawn, end-to-side portacaval shunt is the procedure of choice for the relief of portal hypertension in cirrhosis (6). In 10 such patients, we have made pre-and postoperative comparisons of the standard liver function tests, and the data obtainable from hepatic vein catheterization, namely, hepatic blood flow and oxygen consumption, wedged hepatic venous pressure, and postsinusoidal hepatic vascular resistance. This communication details our findings and discusses their implications on the therapy and pathologic physiology of portal hypertension.
MATERIALS AND METHODSTen patients with end-to-side portacaval anastomoses were the subjects of the study. All were chronic alcoholics and in each, a surgical liver biopsy confirmed the diagnosis of cirrhosis. Esophageal varices were visualized by X-ray in seven cases and by esophagoscopy in 606
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