Abstract
We investigated the portal blood flow, paticularly intra-hepatic shunt, by measuring the level of ammonia in the portal vein (P) and hepatic vein (H), and the ammonia exclusion ratio (P-H) /P. Twentythree patients were evaluated, 14 had an extra-hepatic shunt, and the others had no shunt. As the liver function deteriorated becouse of fibrosis, the level of ammonia in the hepatic vein increased and the ammonia exclusion ratio decreased. In the patients with no extra-hepatic shunt, there was a highly negative correlation between the ammonia exclusion ratio and ICGR15 (r=-0.85). In the patients with an extra-hepatic shunt, there was a highly negative correlation between the ammonia exclusion ratio and ICGR15 after closing the shunt (r=-0.75). Consequently, the ammonia exclusion ratio reflected the degree of liver fibrosis and intra-hepatic shunt. The ammonia exclusion ratio is a useful method for determining the closing of the porto-systemic shunt.
