Presinusoidal portal hypertension in non-alcoholic cirrhosis

Authors

  • Gilles Pomier-Layrargues M. D.,

    Corresponding author
    1. Liver Unit, Department of Medicine and Pathology and Clinical Research Center, Hǒpital Saint-Luc and Université de Montréal, Montréal, Canada H2X 3J4
    • Clinical Research Center, Hopital Saint-Luc, 1058, rue Saint-Denis, Montreal, Quebec, Canada H2X 3J4
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    • Scholar of the Medical Research Council of Canada, Dr. Villeneuve and Dr. Huet Chercheur-Boursier are Scholars of the Ministère des Affaires Sociales du Québec and Dr. Willems is a Scholar of the C. O. Monat Foundation.

  • Daniel Kusielewicz,

    1. Liver Unit, Department of Medicine and Pathology and Clinical Research Center, Hǒpital Saint-Luc and Université de Montréal, Montréal, Canada H2X 3J4
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  • Bernard Willems,

    1. Liver Unit, Department of Medicine and Pathology and Clinical Research Center, Hǒpital Saint-Luc and Université de Montréal, Montréal, Canada H2X 3J4
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  • Jean-Pierre Villeneuve,

    1. Liver Unit, Department of Medicine and Pathology and Clinical Research Center, Hǒpital Saint-Luc and Université de Montréal, Montréal, Canada H2X 3J4
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  • Denis Marleau,

    1. Liver Unit, Department of Medicine and Pathology and Clinical Research Center, Hǒpital Saint-Luc and Université de Montréal, Montréal, Canada H2X 3J4
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  • Jean Cǒté,

    1. Liver Unit, Department of Medicine and Pathology and Clinical Research Center, Hǒpital Saint-Luc and Université de Montréal, Montréal, Canada H2X 3J4
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  • P.-Michel Huet

    1. Liver Unit, Department of Medicine and Pathology and Clinical Research Center, Hǒpital Saint-Luc and Université de Montréal, Montréal, Canada H2X 3J4
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Abstract

The simultaneous measurement of wedged hepatic vein pressure (WHVP) and portal vein pressure (PVP) was performed in 156 cirrhotic patients. In the 110 alcoholic cirrhotic patients (97 micronodular and 13 macronodular cirrhosis), WHVP and PVP were closely related (25.8 ± 6.3 vs. 25.9 ± 6.3 mm Hg; p = not statistically significant). The difference between the two parameters was greater than 4 mm Hg in only six patients. In the 46 patients with nonalcoholic cirrhosis (41 macronodular and 1 micronodular cirrhosis; 4 primary biliary cirrhosis), PVP was significantly higher than was WHVP (25.8 ± 6.2 vs. 21.7 ± 6.8 mm Hg; p < 0.001); in 20 patients, PVP exceeded WHVP by more than 4 mm Hg, and the mean difference was 7.5 mm Hg. There was no correlation between the porto-hepatic gradient and total hepatic blood flow measured by the indocyanine green single injection method or the portal fraction of total hepatic blood flow measured by indicator dilution curves. It is concluded that: (i) measurement of WHVP in alcoholic cirrhosis provides a reliable estimate of the severity of the portal hypertension, and (ii) hemodynamic evaluation of nonalcoholic cirrhosis should include PVP measurement in order to avoid underestimation of the porto-hepatic gradient.

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