Effect of Peroral Administration of Isosorbide Dinitrate on Portal Pressure and Blood Flow in Patients with Cirrhosis of the Liver

The effect of slow-release isosorbide dinitrate, given orally four times daily for 14 days, on the portal circulation was studied in 10 patients with liver cirrhosis and oesophageal varices. Mean arterial pressure and heart rate were not influenced significantly by isosorbide dinitrate. Statistically significant dilation of the portal vein by 11.9% and an increase in blood flow velocity by 35.4% and in portal blood flow rate by 54.3% were observed at the end of therapy. The average wedged hepatic vein pressure was 32.9 mmHg before therapy and after therapy it was decreased to 60.5%. The slight decrease observed in free hepatic vein pressure was not statistically significant. Before treatment the portohepatic gradient was four times above normal and after therapy it fell to 9.5 mmHg. The results indicate that, in patients with portal hypertension, an improvement in haemodynamics can be achieved by the use of isosorbide dinitrate. This improvement may lead to the prevention of bleeding from oesophageal varices.

Spleen Blood Flow and Splanchnic Haemodynamics in Blood Dyscrasia and other Splenomegalies

1. Splenic blood flow and splanchnic haemodynamics have been studied in twenty patients with splenomegaly due to blood dyscrasia or diseases involving the reticuloendothelial system. Thirteen of these patients had portal hypertension, three had abdominal collaterals on arteriovenography and one oesophageal varices. 2. Total spleen blood flow was increased in all with values up to 1550 ml/min, and associated with this liver blood flows increased up to 2·61 1 min−1 m−2. In four patients the cardiac output was raised. 3. In five patients a raised wedged hepatic vein pressure was found which was solely related to the increase in liver blood flow, but in two others, in whom hepatic histology was abnormal, there was also an increase in postsinusoidal resistance. Nine patients had a raised hepatic pre-sinusoidal resistance. This was related to a greatly increased liver blood flow with portal tract fibrosis and cellular infiltration as possible additional factors. 4. The haemodynamic findings in these patients were similar to those found previously in patients with tropical splenomegaly. In both groups spleen blood flow in ml 100 g−1 min−1 was inversely proportional to spleen size. There were similar increases in total spleen and liver blood flows and in the percentage of patients with an increased pre-sinusoidal resistance. In contrast, in cirrhosis there was no inverse relationship between flow in 1 100 g−1 min−1, and of spleen size, and for the degree of splenomegaly total spleen blood flow was relatively greater.