Hemodynamic Guidelines for Surgical Therapy of Portal Hypertension

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Abstract
A prospective study of 98 patients with portal hypertension who hemorrhaged revealed that certain hemodynamic parameters were valuable in confirming the cause of cirrhosis, aiding in the selection of patients best suited for a selective distal splenorenal shunt and in providing an estimate of prognosis. The presence of a pressure gradient of 4 mm Hg or more between the right atrium and inferior vena cava was observe only in patients with alcoholic cirrhosis. The shape of the pull-back tracing between the wedge and free hepatic vein positions was smooth is postnecrotic disease and lumpy in alcoholic disease. The ratio of the aortic diastolic pressure divided by the hepatic (vein) wedge pressure segregated patients by cause and direction of portal blood flow.