Submitted on April 30, 2007
Accepted on May 15, 2008
The role of hepatic arterial flow on portal venous and hepatic venous wedged pressure in the isolated perfused CCl4-cirrhotic liver
Alexander Zipprich1, Mauricio R. Loureiro-Silva2, Irita D'Silva1, and Roberto J Groszmann3*
1 Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
2 Internal Medicine, Yale UniversitySchool of Medicine, West Haven, Connecticut, United States; Hepatic Hemodynamic Laboratory, Veterans Affairs Medical Center, West Haven, Connecticut, United States
3 Hepatic Hemodynamic Laboratory, Veterans Affairs Medical Center, West Haven, Connecticut, United States; Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
* To whom correspondence should be addressed. E-mail: roberto.groszmann{at}yale.edu.
In cirrhosis, hepatic venous pressure gradient is used to measure portal venous and sinusoidal pressures as well as drug induced decreases of elevated pressures. The aim of this study was to investigate the influence of hepatic arterial flow changes on portal venous perfusion (PVPP) and wedged hepatic venous pressure (WP). Normal and CCl4-cirrhotic rats were subjected to a bivascular liver perfusion with continuous measurements of PVPP, WP, and hepatic arterial perfusion pressure. Flow-pressure curves were performed using different flows either through the portal vein (PVF: 32-20 ml/min) or hepatic artery (HAF: 5-15 ml/min). Increases in HAF lead to significant absolute and relative increases in PVPP (p=0.002) and WP (p<0.001). Absolute changes in HAF correlated to absolute changes in PVPP (cirrhosis: r=0.64, p<0.001; control: r=0.67, p<0.001) and WP (cirrhosis: r=0.71, p<0.001; control: r=0.82, p<0.001). Changes in PVPP correlated to changes in WP due to changes in PVF only in cirrhosis (r=0.75, p<0.001) while changes in HAF correlated in both cirrhosis (r=0.92, p<0.001) and control (r=0.77, p<0.001). In conclusion, increases and decreases in HAF lead to respective changes in PVPP and WP. This suggests a direct influence of HAF on PVPP and WP most likely due to changes in sinusoidal perfusion.
