- Amitava Goswami added an answer:What is the right time to stop non selective beta blocker in portal hypertension?
Left ventricular diastolic dysfunction occurs in 50-70 % of decompensated cirrhosis. However with the development of left ventricular systolic dysfunction or mean arterial pressure < 82mm of hg or Cardiac Index < 1.5 L or refractory ascites; non selective beta blocker should be abandoned.
Window concept for beta blocker is new in portal hypertension. So window period for beta blocker is very short from primary prophylaxis to decompensated cirrhosis without the risk factors (I have already mentioned). Recent studies have shown increased renal failure (HRS) and mortality with beta blocker in refractory ascites, MAP < 82 mm hg, CI < 1.5. In these high risk group endoscopic vareceal ligation is the best alternativeFollowing
- Maher Al zaiem added an answer:Why do patients with diaphragmatic hernia have portal hypertension?Why do patients with diaphragmatic hernia have portal hypertension?what is the percentage of operated patients of diaphragmatic hernia who has portal hypertension?
and if it appears, at what age ?
As pediatric surgeon,i have operated more than 75 cases of different types of diaphragmatic hernia, I have not come across a single case of portal hypertension !Following
- Rustam Zafardjanovich Yuldashev added an answer:Extrahepatic portal hypertension and congenital heart defect. Which should come first?In management of paediatric patients with extrahepatic portal hypertension and congenital heart defect (ASD, VSD or tetralogy of Fallot) which operation must be done first? Correction of heart defect or portal hypertension?I agree with you to,but on the other hand, Horia and Andreas, usually after correction of congenital heart defects often surgeons use anticoagulants to prevent postoperative complications, which increases the risk of gastroesophageal bleeding.Following
- Mario Romano added an answer:What is the reason of cyanosis after mesocaval anastomosis in patient with extrahepatic portal hypertension?in 2006 patient operated due to gastroesophageal bleeding. Operation- end to side iliaco mesenterial anastomosis (v. iliaca communis dextra to v/ mesenterica superior). Year after postoperative period patient began to complain on cyanosis, and clubbing of fingers. SpO2 - 66%. Echocardiography-clear. On angiopulmonography also no evidence of arteriovenous fistula in lungs!The increase of NO determines the opening of arteriovenous shunts in the pulmonary vascular bed that are responsible for the onset of hepatopulmonary syndromeFollowing