Volume : VII, Issue : I, January - 2017

Hepatic Venous Pressure Gradient – A review

Dr Rahul Jain, Dr Kalpana Jain, Lt Col Dr Atul Jha

Abstract :

 BACKGROUND

Portal hypertension is characterised by increasing portal pressures resulting in an increasing gradient between splanchnic and systemic circulation. Measurement of Hepatic Venous Pressure Gradient (HVPG) is the preferred technique for determining portal pressure in present times. This method has replaced direct measurement of portal pressure. It has been proven that the values of HVPG correlate to various outcomes in patients with cirrhosis (compensated or decompensated) and ACLF. The role of HVPG continues to evolve and has been diversified in the evaluation of chronic hepatitis, hepatocellular carcinoma (HCC) and pre–transplant assessment. Measurement of HVPG the preferred technique for determining portal pressure has replaced direct measurement of portal pressure.¹ WHVP is measured by occluding one of the main hepatic veins (mostly right hepatic vein).² WHVP is a measure of hepatic sinusoidal pressure, not of portal pressure thus WHVP will be an underestimation of portal venous pressure (PVP) if a pre–sinusoidal resistance is present. In the normal liver WHVP is slightly lower (by ~1 mmHg) than portal pressure, due to pressure equiliation through the interconnected sinusoids.³ WHVP gives an accurate estimate of portal pressure, as has been demonstrated both for alcoholic and viral cirrhosis.⁴ FHVP is measured in unoccluded hepatic vein. It is the FHVP that should be used to calculate the hepatic venous pressure gradient and not the right atrial pressure because HVPG calculated with right atrial pressure shows a worse correlation with clinical outcomes.⁵ HVPG is better than WHVP and FHVP because they are affected by intra–abdominal pressure, but the gradient (HVPG) is not.⁶

MATERIALS AND METHODS

We evaluated the role of HVPG as a predictor of complications and outcomes in patients with liver disease (ACLF and cirrhosis). 

Keywords :

Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

Dr Rahul Jain, Dr Kalpana Jain, Lt col (Dr) Atul Jha, Hepatic Venous Pressure Gradient – A review, Indian Journal of Applied Research,Volume : 7 | Issue : 1 | JANUARY 2017

Number of Downloads : 606

References :