Since Banti described a series of cases characterized not only by splenomegaly but also by a terminal cirrhosis of the liver as Morbus Banti in 1894, a problem concerning the independency of this desease has been the center of some dispute.
Whipple, having established the concept of portal hypertension, classified the concept into two types from the view point of the obstructive site of the portal blood flow, namely, intrahepatic (portal cirrhosis and thrombosis of the hepatic vein) and extrahepatic (Banti's syndrome) in 1945.
However, Whipple's classification seems logically untenable. There were some cases with marked esophageal varices and splenomegaly which demonstrated no cirrhotic findings and no extrahepatic obstruction.In 1960 Professor Imanaga classified portal hypertension into 4 groups from the results of his investigation of the intrahepatic circulation in 255 cases with portal hypertention as follows.
I. Extrahepatic portal vein obstruction.
II. Intrahepatic portal vein obstruction.
III-1. Intrahepatic hepatic vein obstruction.
III-2. Intrahepatic hehatic and portal vein obstruction.
IV. Extrahepatic hepatic vein obstruction.
To demonstrate the characteristic intrahepatic circulation of these groups, especially of Group II and Group III, this writer devised and performed a clinical determination of the ratio of the portal venous blood which flows into liver to the hepatic arterial blood which flows into liver.
A No.8 F. Cornand Catheter was inserted into one of the right hepatic veins in a free position and the other into the right branch of the portal vein.
Then, 11 samplings of each blood of 2 cc.from the hepatic vein and the portal vein were successively drawn by syringes every 3 seconds, following the injection of 2 cc. of 0.5% Evans blue into the epigastric vein for 5 seconds. Serum was separated and the amount of the dye in serum was determined by colorimetric technique.
Each of concentration curves of the hepatic vein and portal vein is shown on the accompanying graph.
Portal blood flow/Hepatic blood flow=Area of the concentratlon curve of the hepatic vein/Area of the concentration curve of the hepatic artery
With this method, the measurement of Wedged Hepatic Vein Pressure (WHVP) and Estimated Hepatic Blood Flow (EHBF) by bromsulfalein method and Au¹⁹⁸ colloid method in some cases were carried out in this series.
Results are summarized as follows.
I: Group II (lntrahepatic portal vein obstruction)
1) WHVP was normal with an average of 134 mmH₂0 in 19 cases. Portal pressure was markedly elevated with an average of 361 mmH₂0. The marked discrepancy between the two pressures was demonstrated in this group.
2) The percentage ratio of the portal blood flow which runs into the liver to the total hepatic blood flow was calculated as 18.4%.
3) The hepatic blood flow was normal, or rather increased in some cases than normal subjects with an average of 1075 ml/min, 780 ml/min/m², and 23.6 ml/min/kg.
4) The extrahepatic shunting ratio of the portal blood flow was markedly increased with an average of 77.9% in 3 cases. The mean intrahepatic circulation time via the portal vein was on the average 7.5 seconds in these cases.
5) After end-to-side portacaval anastomosis, WHVP showed almost no change with a mean value of 124 mmH₂0 in 15 cases and EHBF didnot decrease but increased in some cases with a mean ratio of change of +1.2% in 13 cases.
Therefore, it might be concluded that obstructive site of the portal flow of this group consisted in the intrahepatic portal vein and the compensatory increase of the hepatic arterial flow went on smoothly.

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