Effect of Transjugular Intrahepatic Portosystemic Shunt on Systemic Hemodynamics in Liver Cirrhosis

Baik, Soon Koo; Kim, Young Ju; Park, Joong Wha; Suh, Jung In; Kim, Jae Woo; Park, Seong Jin; Kim, Hyun Soo; Lee, Dong Ki; Kwon, Sang Ok; Uh, Young

Abstract

BACKGROUND/AIMS: We conducted this prospective study to identify whether hemodynamic changes occur immediately after transjugular intrahepatic portosystemic shunt (TIPS) in patients with liver cirrhosis and to find out the factors that contribute to the changes.
METHODS
TIPS procedure was performed for 9 cirrhotic patients for the control of recurrent bleeding. Cardiac index, systemic vascular resistance index and pulmonary capillary wedge pressure were measured before and 20 minutes after TIPS using Swan-Ganz catheterization. Concentration of nitric oxide which is known as one of potent vasodilators was measured in the blood of femoral artery using the Griess reaction before and 20 minutes after TIPS.
RESULTS
At 20 minutes after the procedure, the cardiac index was increased from 4.89+/-.89 to 5.91+/-.29 L/min/m2 (p=0.012), and the systemic vascular resistance index was decreased from 776.63+/-97.91 to 586.13+/-80.39 dyne s/cm5/m2 (p=0.012). There was no significant change in the pulmonary capillary wedge pressure which reflects the preload of the left ventricle. The nitric oxide level was increased from 186.25+/-12.37 to 226.02+/-26.73 micro mole/L (p=0.038).
CONCLUSIONS
The cardiac output was increased and the systemic vascular resistance index was decreased immediately after TIPS. These circulatory hyperdynamic changes may have resulted from increased quantity of vasodilators such as nitric oxide. Therefore, we consider that adequate fluid replacement is needed for preventing the systemic vascular complications due to a decrease of effective circulating volume followed immediately after TIPS.