DIRECTION OR REVERSAL OF PRESHUNT PORTAL BLOOD-FLOW AS DETERMINANTS OF OUTCOME UP TO 1 YEAR AFTER SMALL-DIAMETER PROSTHETIC H-GRAFT PORTACAVAL-SHUNT

Partial portal decompression (PPD) is gaining popularity in the treatm ent of portal hypertension. We have achieved PPD in over 80 patients b y utilizing an 8-mm prosthetic H-graft portacaval shunt (HGPCS). We ha ve been pleased with the infrequency of encephalopathy and liver failu re after shunting. While maintenance of portal blood dow would presuma bly play a role in outcome after shunting, changes in portal hemodynam ic occurring within the first year after shunting are generally unknow n. In 31 patients (Child's class 6% A, 61% B, 32% C) of an average age of 55 +/- 13.3 (SD) years undergoing HGPCS, clinical outcome was pros pectively evaluated relative to the direction of portal blood how dete rmined before and after shunting and at 1 year after shunting using co lor-flow Doppler ultrasound. Preshunt hepatopetal flow reversed in 2/2 9 (7%) patients with shunting and in an additional 5/27 (18%) patients by 1 year after shunting. Death (due to alcoholism in 1, old age in 1 ) and encephalopathy (Child's class A = 1, B = 2, C = 1) were uncommon by 1 year after shunting. Eighty-one percent had excellent outcome (a live without encephalopathy or rebleeding) at 1 year. Though preshunt hepatopetal how is generally maintained postshunt and after one year, maintenance of hepatopetal flow does not ensure an excellent outcome a nd reversal of hepatopetal flow does not predispose to a suboptimal ou tcome. Outcome up to 1 year after HGPCS is not determined by direction or reversal of portal blood flow. (C) 1995 Academic Press, Inc.