Portal Hypertension

Abstract

Cirrhosis of the liver is one of the ten great killers in the United States. In spite of an enormous effort in the investigation of therapeutic modalities, there is little evidence that the basic outlook for the cirrhotic has been improved. This has been admirably demonstrated in a report by Garceau and Chalmers, who found death from bleeding to be the greatest single threat to patients with cirrhosis and esophageal varices. Yet, in the randomized studies by Callow et al., and Conn and Lindenmuth, the effectiveness of prophylactic portacaval shunt in prolongation of life was not confirmed; no significant difference has been demonstrated between the control, or non-operative group, and those undergoing portacaval shunt. An analysis of this data by Warren et al., reveals that the shunt successfully prevents death from bleeding, but an increased death rate from hepatic failure is substituted in the surgical group. By comparison, in an analysis of a non-shunting procedure by Johnson et al.,. re-bleeding was quite common, but hepatic failure did not appear to be accelerated in the survivors of the operation. Because of our belief that change in hepatic hemodynamics is one of the major factors influencing the fate of persons undergoing portacaval shunt, extensive hemodynamic studies have been carried out in over 150 patients with various complications of cirrhosis of the liver. There is a growing conviction that a thorough understanding of the hemodynamic implications of any operative procedure must be achieved before optimal therapy can be chosen for the individual patient.