Sonographic hemodynamic evaluation of spleno-renal shunt using the Valsalva maneuver
ABSTRACT PurposeThe purpose of this study was to assess the characteristic features of hemodynamic changes in portal venous hypertension with
spleno-renal shunt on conventional B-mode and color Doppler imaging before and after the Valsalva maneuver.
Materials and methodsA total of 11 patients with portal venous hypertension underwent conventional B-mode and color Doppler ultrasound during follow-up
examinations. Sonographic imaging of the splenic vein and the left renal vein was performed before and after the Valsalva
ResultsIn the six patients with spleno-renal shunt formation, dilated left renal veins were depicted after the Valsalva maneuver.
In the five patients without spleno-renal shunt, there was no apparent dilatation of the left renal vein either before or
after the Valsalva maneuver. In all six patients with spleno-renal shunt, color flow mapping of the left renal veins was emphasized
during the Valsalva maneuver. In the five patients without spleno-renal shunt formation, there were no apparent changes on
color flow mapping of the left renal vein before or after the Valsalva maneuver.
ConclusionThe sonographic findings of the splenic vein and the left renal vein on conventional B-mode and color Doppler imaging before
and after the Valsalva maneuver are useful for diagnosis of spleno-renal shunt and for grading the hemodynamic changes caused
by spleno-renal shunt.
KeywordsPortal venous hypertension-Spleno-renal shunt-Collateral circulation-Color Doppler ultrasonography-Hemodynamics
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ABSTRACT: Portal hypertension (PHT) is associated with a hyperdynamic state characterized by a high cardiac output, increased total blood volume, and a decreased splanchnic vascular resistance. This splanchnic vasodilation is a result of an important increase in local and systemic vasodilators (nitric oxide, carbon monoxide, prostacyclin, endocannabinoids, and so on), the presence of a splanchnic vascular hyporesponsiveness toward vasoconstrictors, and the development of mesenteric angiogenesis. All these mechanisms will be discussed in this review. To decompress the portal circulation in PHT, portosystemic collaterals will develop. The presence of these portosystemic shunts are responsible for major complications of PHT, namely bleeding from gastrointestinal varices, encephalopathy, and sepsis. Until recently, it was accepted that the formation of collaterals was due to opening of preexisting vascular channels, however, recent data suggest also the role of vascular remodeling and angiogenesis. These points are also discussed in detail.The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 07/2008; 291(6):699-713. · 1.34 Impact Factor
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ABSTRACT: This study aimed to determine the detection rate and clinical relevance of portosystemic collaterals. We studied 326 cirrhotics. Portosystemic collaterals, portal vein diameter, and splenic area were evaluated by color Doppler sonography; esophageal varices were detected by endoscopy. Of the cirrhotics, 130 had portosystemic collaterals (39.9% total, left gastric vein 11%, paraumbilical vein 7.4%, splenorenal shunts 13.8%, and combined shunts 7.7%). Cirrhotics without portosystemic collaterals or with a paraumbilical vein had a significantly narrower portal vein diameter than cirrhotics with a left gastric vein (P < 0.001). Cirrhotics with a paraumbilical vein had a significantly smaller splenic area than cirrhotics with a left gastric vein (P < 0.001), splenorenal shunts (P < 0.001), combined shunts (P < 0.001), or without portosystemic collaterals (P < 0.05). A significant association between portosystemic collaterals and Child's classes or presence and type of esophageal varices was found (P < 0.0001 and P = 0.0004, respectively). The highest prevalence of Child's class C and large (F-3) esophageal varices was found in cirrhotics with a left gastric vein (41.7% and 36.1%, respectively), whereas esophageal varices were absent in 47.4% of cirrhotics without portosystemic collaterals and in 58.3% of cirrhotics with a paraumbilical vein. The left gastric vein is associated with some sonographic and clinical markers of disease severity, whereas the absence of portosystemic collaterals or the presence of paraumbilical veins seems to identify cirrhotics with markers predictive of a more favorable clinical course.Journal of Gastroenterology 01/2009; 44(1):76-83. · 3.79 Impact Factor