Measurement of hepatic vein pressure gradient in children with chronic liver diseases

Roberto Miraglia, Angelo Luca, Luigi Maruzzelli, Marco Spada, Silvia Riva, Settimo Caruso, Giuseppe Maggiore, Bruno Gridelli, Jaime Bosch

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background & Aims: The aim of this study is to present our preliminary experience with Hepatic Vein Pressure Gradient (HVPG) measurements in pediatric patients with chronic liver disease. Methods: Institutional review board approval was obtained. HVPG was measured in 20 pediatric patients, mean age 82 ± 54 months, with chronic liver disease, without extrahepatic portal vein obstruction. In nine patients the end-stage liver disease was secondary to biliary atresia; in the remaining 11, to various causes. Eleven patients had esophageal varices at endoscopy, 14 had perigastric and periesophageal collaterals at imaging scan, three had ascites, 12 had low platelet count, and all had splenomegaly. Results: Hepatic vein catheterization was technically possible in all patients without complications. HVPG values were elevated in all but three patients, ranging between 2 and 33 mmHg (mean 11.3 ± 7.2 mmHg), thus indicating a sinusoidal component in portal hypertension. A salient finding was the presence of hepatic venovenous shunts in 7 out of 9 patients with biliary atresia; however, the HVPG could still be measured distal to the shunts, but in three patients (with an HVPG of 8 mmHg) it was determined in an area with a small venovenous communication still visible, therefore underestimating the actual portal pressure gradient. No venovenous shunts were detected in the non-biliary atresia patients. Conclusions: HVPG is a feasible procedure in pediatric patients. Patients with biliary atresia very frequently have communicating vessels between hepatic veins. This hitherto unacknowledged finding can lead to the underestimation of portal pressure by HVPG measurement.

Original languageEnglish
Pages (from-to)624-629
Number of pages6
JournalJournal of Hepatology
Volume53
Issue number4
DOIs
Publication statusPublished - Oct 2010

Fingerprint

Hepatic Veins
Liver Diseases
Chronic Disease
Pressure
Biliary Atresia
Portal Pressure
Pediatrics
End Stage Liver Disease
Esophageal and Gastric Varices
Research Ethics Committees
Splenomegaly
Portal Hypertension
Portal Vein
Platelet Count
Ascites
Catheterization
Endoscopy
Communication

Keywords

  • Ascites
  • Biliary atresia
  • Diagnosis
  • Pediatrics
  • Variceal bleeding

ASJC Scopus subject areas

  • Hepatology

Cite this

Measurement of hepatic vein pressure gradient in children with chronic liver diseases. / Miraglia, Roberto; Luca, Angelo; Maruzzelli, Luigi; Spada, Marco; Riva, Silvia; Caruso, Settimo; Maggiore, Giuseppe; Gridelli, Bruno; Bosch, Jaime.

In: Journal of Hepatology, Vol. 53, No. 4, 10.2010, p. 624-629.

Research output: Contribution to journalArticle

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AU - Caruso, Settimo

AU - Maggiore, Giuseppe

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N2 - Background & Aims: The aim of this study is to present our preliminary experience with Hepatic Vein Pressure Gradient (HVPG) measurements in pediatric patients with chronic liver disease. Methods: Institutional review board approval was obtained. HVPG was measured in 20 pediatric patients, mean age 82 ± 54 months, with chronic liver disease, without extrahepatic portal vein obstruction. In nine patients the end-stage liver disease was secondary to biliary atresia; in the remaining 11, to various causes. Eleven patients had esophageal varices at endoscopy, 14 had perigastric and periesophageal collaterals at imaging scan, three had ascites, 12 had low platelet count, and all had splenomegaly. Results: Hepatic vein catheterization was technically possible in all patients without complications. HVPG values were elevated in all but three patients, ranging between 2 and 33 mmHg (mean 11.3 ± 7.2 mmHg), thus indicating a sinusoidal component in portal hypertension. A salient finding was the presence of hepatic venovenous shunts in 7 out of 9 patients with biliary atresia; however, the HVPG could still be measured distal to the shunts, but in three patients (with an HVPG of 8 mmHg) it was determined in an area with a small venovenous communication still visible, therefore underestimating the actual portal pressure gradient. No venovenous shunts were detected in the non-biliary atresia patients. Conclusions: HVPG is a feasible procedure in pediatric patients. Patients with biliary atresia very frequently have communicating vessels between hepatic veins. This hitherto unacknowledged finding can lead to the underestimation of portal pressure by HVPG measurement.

AB - Background & Aims: The aim of this study is to present our preliminary experience with Hepatic Vein Pressure Gradient (HVPG) measurements in pediatric patients with chronic liver disease. Methods: Institutional review board approval was obtained. HVPG was measured in 20 pediatric patients, mean age 82 ± 54 months, with chronic liver disease, without extrahepatic portal vein obstruction. In nine patients the end-stage liver disease was secondary to biliary atresia; in the remaining 11, to various causes. Eleven patients had esophageal varices at endoscopy, 14 had perigastric and periesophageal collaterals at imaging scan, three had ascites, 12 had low platelet count, and all had splenomegaly. Results: Hepatic vein catheterization was technically possible in all patients without complications. HVPG values were elevated in all but three patients, ranging between 2 and 33 mmHg (mean 11.3 ± 7.2 mmHg), thus indicating a sinusoidal component in portal hypertension. A salient finding was the presence of hepatic venovenous shunts in 7 out of 9 patients with biliary atresia; however, the HVPG could still be measured distal to the shunts, but in three patients (with an HVPG of 8 mmHg) it was determined in an area with a small venovenous communication still visible, therefore underestimating the actual portal pressure gradient. No venovenous shunts were detected in the non-biliary atresia patients. Conclusions: HVPG is a feasible procedure in pediatric patients. Patients with biliary atresia very frequently have communicating vessels between hepatic veins. This hitherto unacknowledged finding can lead to the underestimation of portal pressure by HVPG measurement.

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