Oxygen Supply to the Cirrhotic Liver Following Various Portacaval Shunt Proceudres

Abstract

Hemodynamic measurements have been of limited value in determining the stage of liver cirrhosis and the type of · portacaval shunt to be performed in the presence of portal hypertension and bleeding esophageal varices (Bradley et al. 1953, Reynolds, 1974). The effective perfusion rate and oxygen transport to the tissue, required to sustain regenerative and functional capacity of the residual hepatocytes cannot be detected by determination of intraoperatively obtained hemodynamic parameters such as portal venous flow and pressure, wedged hepatic pressure and hepatic arterial flow because of the various compartments of intrahepatic blood circulation, the severely altered liver anatomy and an unknown portion of the hepatic inflow which is routed through func-tionless intrahepatic anastomoses (Price et al.1967). The necessity of portal venous decompression requires the shunting of the nutritional and oxygen enriched portal blood into the systemic circulation, leaving the cirrhotic liver with an arterial inflow through the hepatic artery only.