Hemodynamic assessment in clinical practice in portal hypertensive cirrhotics

Abstract

SUMMARY
With the advent of the balloon catheter technique for the
measurement of HVPG, portal hemodynamics can be studied
safely, conveniently and accurately. Evaluation of portal
hemodynamics not only provides information in diagnosing
the etiologies of portal hypertension, it is also essential
in evaluating efficacy of various treatments for this
devastating syndrome. Furthermore, HVPG has also been
shown to correlate with survival prognosis in patients with
end-stage liver disease. In light of the current shortage of
donor organs, the role of HVPG in classification of liver
transplantation candidates should be worth future investigation.
In addition, although HVPG by itself is not a reliable
predictor of variceal hemorrhage, it has been suggested
that serial measurements of HVPGs may be a better risk
prognosticator. This issue also deserves further investigation.
Recently, HVPG has assumed an importance in the
pre-operative assessment in cirrhotics, even though this
prognostic value was derived from a specific situation, hepatic
resection in early HCC. Before a definite recommendation
can be made regarding other types of surgery, future
studies should compare HVPG with conventional tools
such as Child/Pugh classification score. Lastly, non-invasive
methods of quantitative portal hemodynamic measure-ment should be compared directly with HVPG in order to
further define their roles in the evaluation of portal hypertension.
Key Words: portal hypertension, hepatic venous pressure
gradient, esophageal varices, variceal hemorrhage, hepatocellular carcinoma, cirrhosis