Direction or reversal of preshunt portal blood flow as determinants of outcome up to 1 year after small-diameter prosthetic H-graft portacaval shunt.

Partial portal decompression (PPD) is gaining popularity in the treatment of portal hypertension. We have achieved PPD in over 80 patients by utilizing an 8-mm prosthetic H-graft portacaval shunt (HGPCS). We have been pleased with the infrequency of encephalopathy and liver failure after shunting. While maintenance of portal blood flow would presumably play a role in outcome after shunting, changes in portal hemodynamic occurring within the first year after shunting are generally unknown. In 31 patients (Child's class 6% A, 61% B, 32% C) of an average age of 55 +/- 13.3 (SD) years undergoing HGPCS, clinical outcome was prospectively evaluated relative to the direction of portal blood flow determined before and after shunting and at 1 year after shunting using color-flow Doppler ultrasound. Preshunt hepatopetal flow reversed in 2/29 (7%) patients with shunting and in an additional 5/27 (18%) patients by 1 year after shunting. Death (due to alcoholism in 1, old age in 1) and encephalopathy (Child's class A = 1, B = 2, C = 1) were uncommon by 1 year after shunting. Eighty-one percent had excellent outcome (alive without encephalopathy or rebleeding) at 1 year. Though preshunt hepatopetal flow is generally maintained postshunt and after one year, maintenance of hepatopetal flow does not ensure an excellent outcome and reversal of hepatopetal flow does not pre-dispose to a suboptimal outcome. Outcome up to 1 year after HGPCS is not determined by direction or reversal of portal blood flow.