Hemodynamic study after devascularization procedure in patients with esophageal varices.

The portal and systemic hemodynamics in 23 patients with esophageal varices caused by portal hypertension were studied by the thermodilution method with a thermodilution catheter. The patients had a mean age of 48.2 years and underwent splenectomy and devascularization with (17 cases) or without cardiectomy (six cases). The initial portal venous blood flow in all 23 patients was 0.99 +/- 0.31 L/min/m2, and this decreased significantly after splenectomy to 0.67 +/- 0.29 L/min/m2 in proportion to the resected spleen weight. The initial portal venous pressure was 36.5 +/- 6.8 cm H2O, and this decreased after splenectomy to 29.1 +/- 5.7 cm H2O but returned to the initial level after the devascularization procedure. Thus the portal hypertensive status was preserved in spite of the reduction in portal venous blood flow. There was no difference in the pattern of portal hemodynamic change between the patients who underwent cardiectomy and those who did not. In conclusion, it is indicated that the portal hemodynamic change after the devascularization procedure was not caused by cardiectomy but by the lack of splenic blood flow to the portal vein after splenectomy.