Hepatic Veins ; physiopathology ; Humans ; Hypertension, Portal ; physiopathology ; Portal Pressure

OBJECTIVESTo investigate the changes in intrahepatic portal systemic shunt flow (IHSF) and their relationship with microspheres induced acute portal hypertension.

METHODSFollowing acute intrahepatic presinusoidal obstruction by intraportal injection of 15 microm diameter microspheres in male Wistar rats, functional hepatic blood flow (FHBF) and IHSF were determined by hepatic sorbitol uptake methods. The percentage of large shunts of diameter > 15 microm were estimated by intraportal injection of 51Cr labeled 15 mum diameter microspheres.

RESULTSIn normal control rats, hepatic sorbitol uptake was 97.9%+/-0.5% and IHSF was negligible, with FHBF equaling total hepatic blood flow [(2.52 +/- 0.23) ml/min x 100 g body weight-1]. Microsphere injection decreased sorbitol uptake to 12.8% +/- 4.3% and further to 4.1% +/- 0.7% when followed by hepatic arterial ligation. In the latter two groups, IHSF (1.46 +/- 0.15 and 1.16 +/- 0.19 ml/min x 100 g body weight-1, respectively) was not significantly different from portal venous flow [(1.36 +/- 0.20) and (1.20 +/- 0.20) ml/min x 100 g body weight-1, respectively; t = 2.013 and t = 2.116]. Portal venous flow remained at 70% of basal values and portal venous pressure only increased by 50% from baseline. 51Cr labeled microsphere shunt fraction through large shunts (> 15 microm) was less than 1.0%.

CONCLUSIONIntrahepatic portasystemic shunts in the normal rat liver predominantly have diameters less than 15 microm and, when activated by intraportal injection of microspheres, they divert up to 70% of portal venous blood flow away from hepatic sinusoids and thereby they reduce acute increases in portal venous pressure.

Animals ; Hepatic Artery ; physiopathology ; Hepatic Veins ; physiopathology ; Hypertension, Portal ; chemically induced ; physiopathology ; Microspheres ; Portal Vein ; physiopathology ; Random Allocation ; Rats ; Rats, Wistar

OBJECTIVETo improve the resectable rate of massive hepatic tumors and operative tolerance of hepatectomy in the treatment of advanced liver cancers.

METHODSSixteen cases of massive hepatic tumors were reviewed. The selective exclusion of hepatic outflow and inflow in hepatectomy was discussed.

RESULTSAll the patients had normal course after the operative procedure and no hepatic coma or other severe hepatic disturbances were observed.

CONCLUSIONWhile the selective exclusion of hepatic outflow and inflow were applied, the resectable rate of massive hepatic tumors and operative tolerance of hepatectomy were improved.

Adult ; Carcinoma, Hepatocellular ; physiopathology ; surgery ; Female ; Hemangioma, Cavernous ; physiopathology ; surgery ; Hepatectomy ; methods ; Hepatic Artery ; surgery ; Hepatic Veins ; surgery ; Humans ; Liver Circulation ; Liver Neoplasms ; physiopathology ; surgery ; Male ; Middle Aged

OBJECTIVETo observe the hemodynamic change and reperfusion injury cause by transient hepatic venous occlusion and transient hepatic inflow occlusion in rats.

METHODSThe rat liver was divided into 3 different areas: the ischemia reperfusion (IR) area: the inflow of the right superior lobe was clamped for half an hour; the non-isolated lobe congestive reperfusion (NIL-CR) area: the outflow of the right median lobe was clamped for half an hour; and the isolated lobe congestive reperfusion (IL-CR) area: the outflow of the left lobe was clamped for half an hour. The flux value and the oxygen saturation of microcirculation were monitored before at clamping for 30 minutes, and on 1 day, 3 days ,and 7 days after reperfusion. The hepatic damage and Suzuki's score were evaluated.

RESULTSAfter clamping for 30 minutes, the flux value in the IR area was significantly higher than in NIL-CR area (P<0.01) and IL-CR area (P<0.01), the oxygen saturation in the IR area was significantly higher than in NIL-CR area (P<0.01) and IL-CR area (P<0.05). Compared with IR area, both NIL-CR area and IL-CR area were found having more severe liver damage in terms of Suzuki's score in early postoperative period (at clamping for 30 minutes and on 1 day, P<0.01). However, there was no significant difference between NIL-CR area and IL-CR area in flux value, oxygen saturation, and Suzuki's score (P>0.05).

CONCLUSIONSHepatic venous occlusion can more effectively decrease the blood perfrusion and oxygen saturation; thus, compared to the IR, CR can result in more severe liver damage. The presence of normal liver tissue around the congestion area can not influence liver damage in transient hepatic venous occlusion.

Animals ; Disease Models, Animal ; Hemodynamics ; Hepatic Veins ; Liver ; physiopathology ; Male ; Microcirculation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; physiopathology

No abstract available.
Hepatic Veins/*physiopathology ; Humans ; Liver Cirrhosis/complications/*diagnosis ; Predictive Value of Tests ; Prognosis ; Severity of Illness Index ; Venous Pressure

Portal hypertension as a consequence of liver cirrhosis is responsible for serious complications such as variceal bleeding, ascites and hepatic encephalopathy. Successful pharmacological treatment of portal hypertension can prevent the risk of the variceal bleeding, and contribute to reduce the morbidity and mortality in patients with liver cirrhosis. To identify the effect of drugs on portal hypertension, portal pressure was evaluated accurately before and after the drug administration. The hepatic venous pressure gradient has been accepted as the gold-standard method for assessing the severity of portal hypertension and the response to drug treatment. The mean hepatic venous pressure gradient was 15.1+/-5.4 mmHg in Korean cirrhotic patients who had experienced variceal bleeding. Non-selective beta blockers are the treatment of choice for primary and secondary prevention of variceal bleeding. The dose of propranolol should be subsequently adjusted until the resting heart rate had been reduced by 25% or less than 55 beats per minute. It has been reported that the optimal dose of propranolol is variable due to racial differences in cardiovascular receptor sensitivity. In Korean patients with portal hypertension and liver cirrhosis, the mean required dose of propranolol to reach target heart rate was 165 mg (range; 80-280 mg). This review covers mainly the results of the pharmacological therapy of portal hypertension in Korean cirrhotic patients.
Adrenergic beta-Antagonists/administration & dosage ; Hepatic Veins ; Humans ; Hypertension, Portal/diagnosis/*drug therapy/physiopathology ; Korea ; Liver Cirrhosis/complications/physiopathology ; Propranolol/administration & dosage ; Venous Pressure/drug effects

To evaluate relationship of maternal hepatic vein Doppler flow parameters and cardiac output (CO) with neonatal birth weight in uncomplicated pregnancies (UP) and pregnancies complicated by fetal growth restriction (FGR) .
 Methods: Hepatic vein impedance index (HVI), venous pulse transit time (VPTT), and CO were measured in women with UP at the 14th-37th weeks and complicated by FGR at the 26th-37th weeks who underwent maternal hepatic hemodynamic and echocardiographic examination during the ultrasonography. After delivery, the birth weight and the birth weight percentile of each neonate in this study were recorded. Correlations among HVI, VPTT, and CO were analyzed.
 Results: In the UP group, HVI, VPTT, and CO changed with the increase of gestation. In the FGR group, HVI was higher, VPTT was shorter, CO and neonatal birth weight were obviously lower than those in the UP at the 26th-37th weeks (P<0.05).
 Conclusion: There is a series of adaptive changes in hepatic venous hemodynamics and CO in UP with the increase of gestation to meet the demand of fetal growth, while the maladaptive changes in hepatic venous hemodynamics and CO in pregnant woman may contribute to FGR.
Birth Weight ; Cardiac Output ; Female ; Fetal Development ; physiology ; Fetal Growth Retardation ; physiopathology ; Hemodynamics ; physiology ; Hepatic Veins ; physiopathology ; Humans ; Infant, Newborn ; Pregnancy ; Ultrasonography, Prenatal

Portal hypertension is a severe consequence of chronic liver diseases and is responsible for the main clinical complications of liver cirrhosis. Hepatic venous pressure gradient (HVPG) measurement is the best available method to evaluate the presence and severity of portal hypertension. Clinically significant portal hypertension is defined as an increase in HVPG to >10 mmHg. In this condition, the complications of portal hypertension might begin to appear. HVPG measurement is increasingly used in the clinical fields, and the HVPG is a robust surrogate marker in many clinical applications such as diagnosis, risk stratification, identification of patients with hepatocellular carcinoma who are candidates for liver resection, monitoring of the efficacy of medical treatment, and assessment of progression of portal hypertension. Patients who had a reduction in HVPG of > or =20% or to < or =12 mmHg in response to drug therapy are defined as responders. Responders have a markedly decreased risk of bleeding/rebleeding, ascites, and spontaneous bacterial peritonitis, which results in improved survival. This review provides clinical use of HVPG measurement in the field of liver disease.
Chronic Disease ; Hemodynamics ; Hemorrhage/etiology ; Hepatic Veins/physiology ; Humans ; Hypertension, Portal/complications ; Liver Cirrhosis/diagnosis ; Liver Diseases/complications/*physiopathology ; Portal Pressure

OBJECTIVETo investigate the availability of liver transplantation with non-heart beating (60 min) donors supplied gaseous oxygen by hepatic vein in cold preservation period in pigs.

METHODSThirty-six pigs were randomly divided into three recipient groups and three donor groups (group A-15 min of warm ischaemia, group B-60 min of warm ischaemia and group C-60 min of warm ischaemia with gaseous oxygen by hepatic vein during cold preservation period). OTL was performed after four hours cold preservation. Postoperative 5 days survival rate of the liver metabolic, function and inflammatory reaction were observed.

RESULTSAll animals in group A and C survived after reperfusion for 5 days, but animals in group B died within 3 hours postreperfusion. The damage of liver construction and function were found in group A and group B. There was no significant difference of the changes between group A and C.

CONCLUSIONSGaseous oxygen persufflation during cold preservation has important protective and resuscitative effect for liver from long-time no-heart beating donors. It was possible to become a promising method for liver transplantation with no-hearbeating donors.

Animals ; Cryopreservation ; Heart Arrest ; physiopathology ; Hepatic Veins ; Liver ; physiopathology ; Liver Function Tests ; Liver Transplantation ; Oxygen ; therapeutic use ; Reperfusion ; Reperfusion Injury ; prevention & control ; Superoxide Dismutase ; therapeutic use ; Swine ; Tissue Donors ; Tissue Preservation ; methods

OBJECTIVETo evaluate the effect of Ginkgo biloba extract (EGb) on hepatic microcirculation and portal hypertension in CCl4 treated rats.

METHODSTwenty-five male Wistar rats were divided into a blank, a CCl4 treated and a CCl4 plus EGb treated group, and all were treated for 10 weeks. The free portal vein pressures were measured through catheterizations. Hepatic sinusoidal endothelial cells and other parameters of hepatic microcirculation were studied with transmission electron microscopy. The amounts of malondialdehyde (MDA), endothelin (ET-1), platelet-activating factor (PAF), nitric oxide (NO), cNOS and iNOS in the liver tissues were determined.

RESULTSThe portal vein pressure of the CCl4 plus EGb treated group was (7.4 +/- 0.6) mm Hg while the pressure of the CCl4 treated group was (8.7 +/- 0.8) mm Hg. Aggregation of blood cells or microthrombosis in hepatic sinusoids, deposition of collagen in hepatic sinusoids and spaces of Disse, injury of endothelial cells and capillarization of hepatic sinusoid were significantly milder in the EGb group. The amounts of MDA, ET-1, PAF, NO and iNOS were markedly lower in the CCl4 plus EGb treated group than in the CCl4 treated group.

CONCLUSIONThe results demonstrated that EGb can decrease the portal vein pressure and improve hepatic microcirculation in CCl4 treated rats. The mechanisms of this effect may involve its inhibition on ET-1, PAF, lipid peroxidation, and down regulation of the hepatic iNOS and NO expressions.

Animals ; Ginkgo biloba ; Hepatic Veins ; pathology ; Hypertension, Portal ; drug therapy ; physiopathology ; Liver Cirrhosis, Experimental ; chemically induced ; drug therapy ; pathology ; physiopathology ; Male ; Microcirculation ; drug effects ; Plant Extracts ; pharmacology ; Rats ; Rats, Wistar