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.
Keywords
Abbreviations:
HVPG (hepatic vein pressure gradient), FHVP (free hepatic vein pressure), WHVP (wedged hepatic vein pressure), IVVS (intra-hepatic venous–venous shunts)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 23, 2010
Accepted:
April 22,
2010
Received in revised form:
April 22,
2010
Received:
November 24,
2009
Identification
Copyright
© 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
