Jie-Fu Huang

Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension : Correlation with esophageal variceal bleeding

Using the color Doppler velocity profile (CDVP), we investigated portal hemodynamics and their relationship with esophageal variceal bleeding (EVB) in patients with cirrhosis and portal hypertension.

Portal vein embolization with ethanol injection via a fine needle in dogs

We devised a method for portal vein embolization with ethanol injection (PVEEI) via a fine needle. Both the efficacy and safety of this procedure were evaluated in 28 dogs. An embolization of the left central and lateral lobes was undertaken with various doses of absolute (95%) ethanol. The smallest dose, 0.25 ml/kg ethanol (n=7), caused the least damage to the liver, but the embolization was not complete. At the highest dose at 1.0 ml/kg, four of the seven dogs died of respiratory arrest; however, embolization was complete in the remaining dogs. All animals tolerated the procedure by 0.5 ml/kg ethanol (n=11) with a satisfactory embolic effect, slight toxicity to the hepatic parenchyma, and only transient changes in liver function. The results suggested that PVEEI is safe and effective when a suitable dose of ethanol is administered. Local overembolization occurred in one dog due to extension of the thrombus, suggesting that the point of puncture should not be near the confluence of the branches. Since a selective portal venous puncture is not difficult to perform under sonographic guidance, PVEEI is expected to be clinically applied.

Evaluation of portal hemodynamic changes following devascularization procedure by using color doppler velocity profile

A devascularization procedure consisting of splenectomy and pericardial devascularization is an effective treatment for esophageal variceal bleeding. To assess the influence of this procedure on portal hemodynamics, the color Doppler velocity profile (CDVP) technique was used to evaluate perioperative portal hemodynamics in 28 cirrhotic patients with portal hypertension who underwent the devascularization procedure. The results showed that postoperative portal trunk (PT) flow volume was significantly reduced by 10.1±8.0 ml/min/kg, and the reduction was closely related to preoperative splenic venous (SV) flow volume, with a correlation coefficient of r=0.65 (p<0.001). Maximum cross-sectional mean velocity (CS-Vmax) and flow volume of right anterior branch (RAB) were lowered after surgery by 2.0±2.6 cm/s and 3.2±2.9 ml/min/kg, respectively, and the reduction in flow volume was closely related to its preoperative level, with a correlation coefficient of r=0.74 (p<0.001). Portal venous pressure (PVP) after surgery was significantly lowered by 6.0±4.9 cm H2O (p<0.001), and the postoperative PVP level bore a close relationship with its preoperative level, with a correlation coefficient of r=0.66 (p<0.01). We conclude, that the CDVP technique presents a useful tool for monitoring postoperative changes in portal hemodynamics. The devascularization procedure markedly relieved portal hyperdynamics by eliminating SV inflow. As a consequence of reduction in PT flow volume and PVP, intrahepatic portal perfusion was greatly reduced after surgery, which may be unfavorable to maintenance of liver function.