Abstract
Portal vein hemodynamics in 26 patients with biliary atresia was investigated using pulsed doppler flowmetry combined with B-mode ultrasonography. From the control study in normal subjects (n=37), the normal range of each parameter of portal vein hemodynamics in children was estimated as follows; (1) Cross-sectional area of the portal trunk: 0.137+0.010×W±0.138×√<1.027+0.0004×(W-21.2)^2>(cm^2), (2) portal venous velocity: 14.2 ±4.4 (cm/sec), (3) Portal venous flow: 104.4+9.24XW±151.4×√<1.027+0.0004×(W-21.2)^2> (ml/min), where W is body weight in kg. Z-score against the control value was applied to estimate the changes in portal vein hemodynamics in patients with biliary atresia. In the subgroup without liver dysfunction or portal hypertension (n=7), the cross-sectional area of the portal trunk and the portal venous flow were significantly increased. In the subgroup with liver dysfunction and no portal hypertension (n=8), the portal venous velocity decreased. In the subgroup with portal hypertension (n=11), the portal venous flow was well maintained owing to an increase of cross-sectional area of portal trunk in 6 patients, but portal vein hemodynamics was deteriorated in the other five patients. These changes in portal vein hemodynamics were found to correspond well to the patients' clinical course. In conclusion, analysis of portal venous hemodynamics is essential to estimate the actual status especially when to determine the timing of liver transplantation in patients with biliary atresia.
