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IMO 1210 Color and power doppler ultrasound for the non-invasive follow up of tips: A five-year experience
s22
Ultrasound in Medicine and Biology
Volume 23, Supplement 1, 1997
IMO 1207
IMO 1209
PORTAL BLOOD FLOW IN RIGHT-SIDED CONGESTIVE HEART FAILURE Sien-Sine Yang, Chi-Hwa Wu, Paul H Chen, Ding-Shinn Chen Div. of Gastroenterolo8y and Cardiology, Cathay General Hosp., and Hepatitis ResearchCtr., National Taiwan Univ. Hosp., Taipei, Taiwan
DUPLEX VENOUS
We studied 20 patients with cardiovascular disorders. All patients had constant systemic blood pressure and body weight > 1 week prior to the study. Cardiac output (CO), left ventricular end-diastolic pressure (LVED), mean aortic pressure (AO), pulmonary wedge pressure (PW), mean pulmonary arterial pressure (PA), mean right atrial pressure @A), right ventricular end-diastolic pressure (RVED) were recorded during cardiac catherization. Ten patients with RVED < 10 mmHg were classified as group 1. The re maining 10 patients with RVED > 10
mmHg were classilied as group 2. Portal profiles were studied using an ultrasonic Doppler witbin 12 h of cardiac catherization. Percentage of peak-to-peak pulsatility (PP) = (max.- min.) I max. frequency shift. CO, AO, and LVJZD were not different between two groups. Group 1 patients had normal PW (14.6 f 7.3 mmHg), PA (25.0 f 8.2 mmHg), RA (4.7 f 2.4 mmHg), and RVED (6.4 f 2.7 mmHg). Group 2 patients had increasedPWP (29.9 f 9.3 mmHg), PA (46.3 f 13.2 mmHg), RA
(17.5 f 5.7 mmHg), and RVED (18.3 f 5.6 mmHg) (P C 0.001). Mean values of maximum portal blood velocity (Vmax), mean portal blood velocity (Vmean), cross-sectional area (Area) and portal blood flow volume @BP) were not different between 2 groups. All group 1 patients had a continuous antegrade portal flow with a mean PP 27.0 f 8.9 % (range: 17%-40%)). All patients in group 2 had pulsatile portal flow with a mean PP 86.6 f 45.6 (range: 43%-194%). One patient had a
transient stagnantand three patients had a transient hepatofugal portal flow, which occurred mainly during the ventricular systole. Vmax, Vmean and PBF had positive correlation with CO (PC 0.001) but not with AO, LVED, PW, PA, RA, and RVED. PP showed a good correlation (PC 0.001) with PW, PA, RA, and RVED but not with CO, AO, and LVED. Our data showed that severeright-sided heart failure may result in transient stagnant and hepatofugal portal blood flow. Reduced cardiac output results in decreasedportal inflow.
DOPPLER ASSESSMENT FLOW IN LIVER DISEASE
OF
HEPATIC
U.K.M. Teicharaeber, M. Gebel, M.P. Manns Department of Gastroenterology and Hepatology, Medical School Hannover, D-30623 Hannover, Germany Purpose: Determine the differences in flow velocities and pattern
of hepatic
venous flow
in health and liver disease.
Methods: Duplex Doppler measurements of the middle hepatic vein (MHV) in sustained mid-inspiration were performed in 25 health subjects, 5 patients with acute hepatitis, I2 patients with chronic hepatitis without cirrhosis and 19 patients with cirrhosis. Maximum flow velocities and flow pattern of the MHV were determined. Three hepatic venous flow components were defined: phase 1 systolic and phase 2 diastolic amplitude, phase 3 regurgitant flow from atrial contraction. Results: Patients with hepatic diseases showed three patterns: triphasic, biphasic and monophasic waveforms. Patients with liver cirrhosis displayed a flattening of the waveform and a decrease in maximum flow velocities (p=O.O3). Maximum flow velocities in the MHV in patients with cirrhosis were -0.17+/-0.08 m/s (chase 1). -0.14 +/0.025 m/s (phase 2) and 0.08 +/-O.Olm/s (phase’j). Patients with acute hepatitis showed an increase of the maximum flow velocities compared to the healthy subjects and patients with chronic hepatitis without cirrhosis were comparable. Conclusions: Diminished flow velocities in cirrhosis can not be explained by vessel compression alone. Cirrhotic changes seem to be responsible for these changes, allowing less pulsation of the liver. In contrast, acute hepatic causes an increase in flow velocities and pulsation, due to compression of the hepatic vein. Duplex Doppler examination is helpful in the assessmentof sever pathophysiological changes of the liver.
IMO 1208
IMO 1210
DIAGNOSTIC SIGNIFICANCE OF SEVERE PORTAL VEIN PULSATILITY IN PATIENTS WITH CARDIAC DISEASE Tania S. G&a, Waldemar A. G&a. King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
COLOR AND POWER DOPPLER ULTRASOUND FOR THE NON-INVASIVE FOLLOW UP OF TIPS: A FIVE-YEAR EXPERIENCE Paolo R&i, Giuseppe Pizzi, Mario Bezzi, Michele Rossi, Guido Bonomo, Marco Coniglio, Plinio Rossi Department of Radiology, University “La Sapienza”, Rome, Italy
PulsaMepo&ilvemxrs%winpatient3withca&cdseasahasbeenasscc4atsd with severe tricuspid regurgitation (TR), suggesting direct transmission of the fluid wave from the right heart through the hepatic sinusoids towards the splanchnic circulation. The aim of our sh@ was to find new explanations for the phenomenon of saver3 portal vein pulsatility (SPP), defined as systdic flowintsmptionorreuersal,Weaxamined35carciac~(meanage~19 yetrs)withSPPtyechx&ogaphy,indu&gDcppleri&-mgaQcnof~ andputslwim.caeesdllldsea?Iemreexdudad.llleuderlyingcIagnosis wasleftvenbicukrdy&zciM&etotoor~iheatdseasein19, mewna(icheartdi~inlOendchroniclungdseasein6cases. Thesevetityof TRwasjuclgedbythe~dtheregugitantjetonthecolorRowi~.Peak pulmonary artery pressure (PAP) was calculated by measuring the right ~ar4ightatlidgla<byDcf@qaddngtherigMabia!passuredEMld fmn the IVC cdlqxibilily index. 17 patients dm-0MaM sevmTRwithsyatdll reverse Row in the h@c vein (I-IV) and PAP of 67*15nmHg. The tinirg 16 patients with mild to mcderate TR and no systolic flow mversal in the HV ~PAPc4~17mmHg,Thwonlyhalfof(he~inwrs~golp demonstrated e grade of TR severe encugh to induce systolic flow reversal in theHVandpossibledrect(ransmissiontothepatalvein.H~,,l~~ wem shc+n to have pulmnary hypertension (PAPGlltlGmmHg). Cmdusims 1.Ourdatasugg&thatsevempulmuxayhypertensionincktces SPPinaspec(ivelydthedegreeofTR, pcesunablybyinaeasinghepatizwmcos outflow resistance with consecutive transsinusoidal shunting between the hepatic artery and portal vein. 2. Severe portal vein pulsatility could thus be used as an additional indicator of s8vere pulmonary hypertension.
Purpose:
to assess
the
efficacy
of
Color
and
Power
Doppler ultrasound (CDI) in the evaluation of patency and in the detection of thrombosis or stenosis of TIPS. Materials and Methods: Between October 1992 and February 1997 190 patients underwent TIPS placement in our Department The patient population has been divided into two separate groups. The first series consist in 82 patients, which underwent CD1 and venography at routinely scheduled follow up intervals). The second series consist of 76 patients, which underwent only CD1 follow up: portal venograms were performed solely on the basis of a suspected shunt disfunction during sonographic examination. Results: First Prouo: in the routine follow up group 212 sonographic-angiographic correlations were available. There were 6 false-negative and 3 false oositive, with overall sensitivity of 83% and specificity bf 95%. 2nd m in this group of 31 correlations (performed because of sonoaraohic suagestion of shunt disfunction), CD1 correctlyp&dicted 2Tstenoses and 5 occlusions, with only one false positive. Thus CD1 was 100% sensitive and 97 % soecific in oredictina shunt malfunction. donclusihs: C61 is highly accurate in identifying a failing shunt. In the absence of clinical skns of shunt insufkiency, it helps to obviate the use of direct portography.
Ultrasound in Medicine and Biology
Volume 23, Supplement 1, 1997
IMO 1207
IMO 1209
PORTAL BLOOD FLOW IN RIGHT-SIDED CONGESTIVE HEART FAILURE Sien-Sine Yang, Chi-Hwa Wu, Paul H Chen, Ding-Shinn Chen Div. of Gastroenterolo8y and Cardiology, Cathay General Hosp., and Hepatitis ResearchCtr., National Taiwan Univ. Hosp., Taipei, Taiwan
DUPLEX VENOUS
We studied 20 patients with cardiovascular disorders. All patients had constant systemic blood pressure and body weight > 1 week prior to the study. Cardiac output (CO), left ventricular end-diastolic pressure (LVED), mean aortic pressure (AO), pulmonary wedge pressure (PW), mean pulmonary arterial pressure (PA), mean right atrial pressure @A), right ventricular end-diastolic pressure (RVED) were recorded during cardiac catherization. Ten patients with RVED < 10 mmHg were classified as group 1. The re maining 10 patients with RVED > 10
mmHg were classilied as group 2. Portal profiles were studied using an ultrasonic Doppler witbin 12 h of cardiac catherization. Percentage of peak-to-peak pulsatility (PP) = (max.- min.) I max. frequency shift. CO, AO, and LVJZD were not different between two groups. Group 1 patients had normal PW (14.6 f 7.3 mmHg), PA (25.0 f 8.2 mmHg), RA (4.7 f 2.4 mmHg), and RVED (6.4 f 2.7 mmHg). Group 2 patients had increasedPWP (29.9 f 9.3 mmHg), PA (46.3 f 13.2 mmHg), RA
(17.5 f 5.7 mmHg), and RVED (18.3 f 5.6 mmHg) (P C 0.001). Mean values of maximum portal blood velocity (Vmax), mean portal blood velocity (Vmean), cross-sectional area (Area) and portal blood flow volume @BP) were not different between 2 groups. All group 1 patients had a continuous antegrade portal flow with a mean PP 27.0 f 8.9 % (range: 17%-40%)). All patients in group 2 had pulsatile portal flow with a mean PP 86.6 f 45.6 (range: 43%-194%). One patient had a
transient stagnantand three patients had a transient hepatofugal portal flow, which occurred mainly during the ventricular systole. Vmax, Vmean and PBF had positive correlation with CO (PC 0.001) but not with AO, LVED, PW, PA, RA, and RVED. PP showed a good correlation (PC 0.001) with PW, PA, RA, and RVED but not with CO, AO, and LVED. Our data showed that severeright-sided heart failure may result in transient stagnant and hepatofugal portal blood flow. Reduced cardiac output results in decreasedportal inflow.
DOPPLER ASSESSMENT FLOW IN LIVER DISEASE
OF
HEPATIC
U.K.M. Teicharaeber, M. Gebel, M.P. Manns Department of Gastroenterology and Hepatology, Medical School Hannover, D-30623 Hannover, Germany Purpose: Determine the differences in flow velocities and pattern
of hepatic
venous flow
in health and liver disease.
Methods: Duplex Doppler measurements of the middle hepatic vein (MHV) in sustained mid-inspiration were performed in 25 health subjects, 5 patients with acute hepatitis, I2 patients with chronic hepatitis without cirrhosis and 19 patients with cirrhosis. Maximum flow velocities and flow pattern of the MHV were determined. Three hepatic venous flow components were defined: phase 1 systolic and phase 2 diastolic amplitude, phase 3 regurgitant flow from atrial contraction. Results: Patients with hepatic diseases showed three patterns: triphasic, biphasic and monophasic waveforms. Patients with liver cirrhosis displayed a flattening of the waveform and a decrease in maximum flow velocities (p=O.O3). Maximum flow velocities in the MHV in patients with cirrhosis were -0.17+/-0.08 m/s (chase 1). -0.14 +/0.025 m/s (phase 2) and 0.08 +/-O.Olm/s (phase’j). Patients with acute hepatitis showed an increase of the maximum flow velocities compared to the healthy subjects and patients with chronic hepatitis without cirrhosis were comparable. Conclusions: Diminished flow velocities in cirrhosis can not be explained by vessel compression alone. Cirrhotic changes seem to be responsible for these changes, allowing less pulsation of the liver. In contrast, acute hepatic causes an increase in flow velocities and pulsation, due to compression of the hepatic vein. Duplex Doppler examination is helpful in the assessmentof sever pathophysiological changes of the liver.
IMO 1208
IMO 1210
DIAGNOSTIC SIGNIFICANCE OF SEVERE PORTAL VEIN PULSATILITY IN PATIENTS WITH CARDIAC DISEASE Tania S. G&a, Waldemar A. G&a. King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
COLOR AND POWER DOPPLER ULTRASOUND FOR THE NON-INVASIVE FOLLOW UP OF TIPS: A FIVE-YEAR EXPERIENCE Paolo R&i, Giuseppe Pizzi, Mario Bezzi, Michele Rossi, Guido Bonomo, Marco Coniglio, Plinio Rossi Department of Radiology, University “La Sapienza”, Rome, Italy
PulsaMepo&ilvemxrs%winpatient3withca&cdseasahasbeenasscc4atsd with severe tricuspid regurgitation (TR), suggesting direct transmission of the fluid wave from the right heart through the hepatic sinusoids towards the splanchnic circulation. The aim of our sh@ was to find new explanations for the phenomenon of saver3 portal vein pulsatility (SPP), defined as systdic flowintsmptionorreuersal,Weaxamined35carciac~(meanage~19 yetrs)withSPPtyechx&ogaphy,indu&gDcppleri&-mgaQcnof~ andputslwim.caeesdllldsea?Iemreexdudad.llleuderlyingcIagnosis wasleftvenbicukrdy&zciM&etotoor~iheatdseasein19, mewna(icheartdi~inlOendchroniclungdseasein6cases. Thesevetityof TRwasjuclgedbythe~dtheregugitantjetonthecolorRowi~.Peak pulmonary artery pressure (PAP) was calculated by measuring the right ~ar4ightatlidgla<byDcf@qaddngtherigMabia!passuredEMld fmn the IVC cdlqxibilily index. 17 patients dm-0MaM sevmTRwithsyatdll reverse Row in the h@c vein (I-IV) and PAP of 67*15nmHg. The tinirg 16 patients with mild to mcderate TR and no systolic flow mversal in the HV ~PAPc4~17mmHg,Thwonlyhalfof(he~inwrs~golp demonstrated e grade of TR severe encugh to induce systolic flow reversal in theHVandpossibledrect(ransmissiontothepatalvein.H~,,l~~ wem shc+n to have pulmnary hypertension (PAPGlltlGmmHg). Cmdusims 1.Ourdatasugg&thatsevempulmuxayhypertensionincktces SPPinaspec(ivelydthedegreeofTR, pcesunablybyinaeasinghepatizwmcos outflow resistance with consecutive transsinusoidal shunting between the hepatic artery and portal vein. 2. Severe portal vein pulsatility could thus be used as an additional indicator of s8vere pulmonary hypertension.
Purpose:
to assess
the
efficacy
of
Color
and
Power
Doppler ultrasound (CDI) in the evaluation of patency and in the detection of thrombosis or stenosis of TIPS. Materials and Methods: Between October 1992 and February 1997 190 patients underwent TIPS placement in our Department The patient population has been divided into two separate groups. The first series consist in 82 patients, which underwent CD1 and venography at routinely scheduled follow up intervals). The second series consist of 76 patients, which underwent only CD1 follow up: portal venograms were performed solely on the basis of a suspected shunt disfunction during sonographic examination. Results: First Prouo: in the routine follow up group 212 sonographic-angiographic correlations were available. There were 6 false-negative and 3 false oositive, with overall sensitivity of 83% and specificity bf 95%. 2nd m in this group of 31 correlations (performed because of sonoaraohic suagestion of shunt disfunction), CD1 correctlyp&dicted 2Tstenoses and 5 occlusions, with only one false positive. Thus CD1 was 100% sensitive and 97 % soecific in oredictina shunt malfunction. donclusihs: C61 is highly accurate in identifying a failing shunt. In the absence of clinical skns of shunt insufkiency, it helps to obviate the use of direct portography.